Active NPI
Jacqueline Wilson Martin
- Lodging Provider
- Reidsville, NC
National Provider Identifier
1073667226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Lodging Provider
- License
- FCL-079-037
- Practice address
- 538 Warriner St
Reidsville, NC 27320-3053 - Phone
- (336) 348-6902
- NPI assigned
- Jan 23, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Lodging Provider | 177F00000X | FCL-079-037 | NC | Primary |
Addresses
Primary practice location
538 Warriner St
Reidsville, NC 27320-3053
Mailing address
210 S Van Buren Rd
Eden, NC 27288-5025
Phone (336) 577-2173
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7803777 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FCL-079-037 | NC | MD | Lodging Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073667226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 S VAN BUREN RD",
"city": "EDEN",
"state": "NC",
"postal_code": "272885025",
"telephone_number": "336-577-2173",
"fax_number": "336-589-1320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "538 WARRINER ST",
"city": "REIDSVILLE",
"state": "NC",
"postal_code": "273203053",
"telephone_number": "336-348-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JACQUELINE",
"middle_name": "WILSON",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "177F00000X",
"taxonomy_group": "",
"desc": "Lodging",
"state": "NC",
"license": "FCL-079-037",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7803777",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Reidsville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.