Provider Demographics
NPI:1821377995
Name:ALICE M. MARTINSON, M.D.
Entity Type:Organization
Organization Name:ALICE M. MARTINSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-423-3774
Mailing Address - Street 1:408 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4320
Mailing Address - Country:US
Mailing Address - Phone:870-423-3774
Mailing Address - Fax:870-423-4670
Practice Address - Street 1:408 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4320
Practice Address - Country:US
Practice Address - Phone:870-423-3774
Practice Address - Fax:870-423-4670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALICE M. MARTINSON, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-08
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN7648332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies