Provider Demographics
NPI:1699964247
Name:MARTIN, ALICE DALE (RDMS, RVT)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:DALE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 QUIVIRA RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2309
Mailing Address - Country:US
Mailing Address - Phone:913-541-3377
Mailing Address - Fax:913-541-8082
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 230
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-3377
Practice Address - Fax:913-541-8082
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
722622471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72262OtherRDMS,RVT
KSH070000OtherMEDICARE GROUP