Provider Demographics
NPI:1902086499
Name:MARTINEZ DIABETIC FOOTWEAR
Entity Type:Organization
Organization Name:MARTINEZ DIABETIC FOOTWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-368-3252
Mailing Address - Street 1:402 VOSS AVE
Mailing Address - Street 2:PO BOX 721
Mailing Address - City:ODEM
Mailing Address - State:TX
Mailing Address - Zip Code:78370
Mailing Address - Country:US
Mailing Address - Phone:361-368-3252
Mailing Address - Fax:
Practice Address - Street 1:402 VOSS AVE
Practice Address - Street 2:
Practice Address - City:ODEM
Practice Address - State:TX
Practice Address - Zip Code:78370
Practice Address - Country:US
Practice Address - Phone:361-368-3252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148099801Medicaid
TX4306330001Medicare NSC