Provider Demographics
NPI:1740570605
Name:ORTHO MART INC
Entity Type:Organization
Organization Name:ORTHO MART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-470-6655
Mailing Address - Street 1:14025 SW 142ND AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6756
Mailing Address - Country:US
Mailing Address - Phone:786-470-6655
Mailing Address - Fax:305-378-0568
Practice Address - Street 1:14025 SW 142ND AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6756
Practice Address - Country:US
Practice Address - Phone:786-470-6655
Practice Address - Fax:305-378-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherPENDING MEDICARE