Active NPI
Martin Maytubby Sr.
- Substance Abuse Rehabilitation Facility
- Ardmore, OK
National Provider Identifier
1083923213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- 821
- Practice address
- 9 10TH Ave NW
Ardmore, OK 73401-5929 - Phone
- (580) 226-1656
- NPI assigned
- Oct 5, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 821 | OK | Primary |
Addresses
Primary practice location
9 10TH Ave NW
Ardmore, OK 73401-5929
Mailing address
9 10TH Ave NW
Ardmore, OK 73401-5929
Phone (580) 226-1656
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 |
|---|---|---|---|
| 821 | OK | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318550400000",
"number": "1083923213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 10TH AVE NW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734015929",
"telephone_number": "580-226-1656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 10TH AVE NW",
"city": "ARDMORE",
"state": "OK",
"postal_code": "734015929",
"telephone_number": "580-226-1656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYTUBBY",
"first_name": "MARTIN",
"name_suffix": "Sr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-05",
"last_updated": "2011-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "OK",
"license": "821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.