Provider Demographics
NPI:1013445584
Name:EVAN MEHAN MOTORSPORTS LLC
Entity Type:Organization
Organization Name:EVAN MEHAN MOTORSPORTS LLC
Other - Org Name:MARTIN MEDICAL SUPPLIES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-804-7026
Mailing Address - Street 1:828 SE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-5610
Mailing Address - Country:US
Mailing Address - Phone:954-415-2255
Mailing Address - Fax:
Practice Address - Street 1:828 SE 8TH AVE
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-5610
Practice Address - Country:US
Practice Address - Phone:954-804-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies