Provider Demographics
NPI:1982449609
Name:MARTIN, AMECO L (BSIS)
Entity type:Individual
Prefix:
First Name:AMECO
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 W 25TH ST UNIT 241022
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-5836
Mailing Address - Country:US
Mailing Address - Phone:317-912-8000
Mailing Address - Fax:
Practice Address - Street 1:1956 HOLLOWAY AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-3545
Practice Address - Country:US
Practice Address - Phone:317-912-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016835253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care