Provider Demographics
NPI:1649625401
Name:CHRISTINE MARTINEZ INDEPENDENT CASE MANAGEMENT LLC
Entity type:Organization
Organization Name:CHRISTINE MARTINEZ INDEPENDENT CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-639-4387
Mailing Address - Street 1:3420 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3624
Mailing Address - Country:US
Mailing Address - Phone:620-639-4387
Mailing Address - Fax:
Practice Address - Street 1:3420 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3624
Practice Address - Country:US
Practice Address - Phone:620-639-4387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty