Provider Demographics
NPI:1992754584
Name:TONY MARTIN LIMB AND BRACE, LLC
Entity type:Organization
Organization Name:TONY MARTIN LIMB AND BRACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:ED
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:520-790-7755
Mailing Address - Street 1:5721 E 5TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2401
Mailing Address - Country:US
Mailing Address - Phone:520-790-7755
Mailing Address - Fax:520-790-7765
Practice Address - Street 1:5721 E 5TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2401
Practice Address - Country:US
Practice Address - Phone:520-790-7755
Practice Address - Fax:520-790-7765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5732160001Medicare NSC