Provider Demographics
NPI:1689623662
Name:MARTHA J. HERRING, MD PC
Entity Type:Organization
Organization Name:MARTHA J. HERRING, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-815-8120
Mailing Address - Street 1:4700 FORUM BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5654
Mailing Address - Country:US
Mailing Address - Phone:573-449-4936
Mailing Address - Fax:573-449-6795
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 260
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-815-8120
Practice Address - Fax:573-449-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO199366OtherBLUE CROSS BLUE SHIELD
MODE6831OtherRAILROAD MEDICARE
MO5000093505Medicaid
MO720350OtherHEALTHLINK PROVIDER NUMBE
MOG32075OtherMERCY