Provider Demographics
NPI:1912114844
Name:A S MARTIN ORTHOPEDICS PC
Entity Type:Organization
Organization Name:A S MARTIN ORTHOPEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-898-2663
Mailing Address - Street 1:5546 S FORT APACHE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7692
Mailing Address - Country:US
Mailing Address - Phone:702-898-2663
Mailing Address - Fax:702-304-2663
Practice Address - Street 1:5546 S FORT APACHE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7692
Practice Address - Country:US
Practice Address - Phone:702-898-2663
Practice Address - Fax:702-304-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100965Medicare ID - Type Unspecified
NVI14174Medicare UPIN