MARTIN HEALTH SERVICES INC (MARTIN HEALTH SERVICES INC) - NPI NUMBER 1699949560

Summary

Provider Name: MARTIN HEALTH SERVICES INC (MARTIN HEALTH SERVICES INC)

NPI Number: 1699949560

Clasification: Pharmacy (3336L0003X)

Specialization: Long Term Care Pharmacy

Address:
5500 WEST PKWY
JOHNSTON, IA
ZIP 50131

Phone Number: (515) 986-3054



Detailed Information

MARTIN HEALTH SERVICES INC is a long term care pharmacy pharmacy in Johnston, IA. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. The assigned NPI number for this provider is 1699949560 and is registered as an organization entity type.
The provider Is Doing Business As Martin Health Services Inc.

The provider's business address is:

5500 WEST PKWY
JOHNSTON, IA
ZIP 50131-291
Phone: (515) 986-3054
Fax: (515) 986-3679

The provider's authorized official is Tina Moeller .
The authorized official title is President and has the following contact phone number (319) 984-5680.

The enumeration date for this NPI number is 4/22/2008 and was last updated on 12/30/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336L0003X Pharmacy Long Term Care Pharmacy 1343 IA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 2030477 OTHER PK
2 0702105 MEDICAID IA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1699949560 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MARTIN HEALTH SERVICES INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name MARTIN HEALTH SERVICES INC Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 5500 WEST PKWY The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name JOHNSTON The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name IA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 501312291 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 5159863054 The telephone number associated with the location address of the provider being identified.
13 Provider Business Practice Location Address Fax Number 5159863679 The fax number associated with the location address of the provider being identified.
14 Provider Enumeration Date 4/22/2008 The date the provider was assigned a unique identifier (assigned an NPI).
15 Last Update Date 12/30/2014 The date that a record was last updated or changed.
16 Authorized Official Last Name MOELLER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
17 Authorized Official First Name TINA The first name of the authorized official.
18 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
19 Authorized Official Telephone Number 3199845680 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 3336L0003X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 1343 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 IA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 2030477 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Issuer 1 PK
27 Other Provider Identifier 2 0702105 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 IA
30 Is Organization Subpart N

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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