Provider Demographics
NPI:1922209782
Name:MARTIN ENTERPRISES,INC.
Entity Type:Organization
Organization Name:MARTIN ENTERPRISES,INC.
Other - Org Name:WILLIAM L. MARTIN II
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-993-4135
Mailing Address - Street 1:1030 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-4257
Mailing Address - Country:US
Mailing Address - Phone:865-993-4135
Mailing Address - Fax:865-993-4108
Practice Address - Street 1:1030 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-4257
Practice Address - Country:US
Practice Address - Phone:865-993-4135
Practice Address - Fax:865-993-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3092338OtherBCBS
TN101578OtherBLACK LUNG
TN81121OtherCARITEN
TN3304152Medicaid
TN8951851OtherCIGNA
TN60054OtherAETNA
TN3304152Medicare ID - Type UnspecifiedDR. MARTIN INDIVIDUAL PRO
TN8951851OtherCIGNA
TN60054OtherAETNA