Martin, Jerry

Martin, Jerry is an individual health care provider with primary practice located at 1 Hospital Dr , Columbia MO 65212-0001. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Martin, Jerry can be contacted via phone (573) 882-2568.

Contact Information

Primary practice address
1 Hospital Dr Columbia MO 65212-0001
Phone: (573) 882-2568
Fax: (573) 882-2226
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X RN307552 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 070444 Missouri

Profile Details

NPI number 1831182872
LBN Legal business name Martin, Jerry
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated May 10th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831182872 NPPES
Ohio Other 000000325469 ANTHEM BCBS
Ohio MEDICAID 2442771 ANTHEM BCBS
Ohio MEDICAID 912787918 ANTHEM BCBS

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