Organization
MARTIN MEMORIAL PHYSICIAN CORPORATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (EXECUTIVE VP CHIEF FINANCE OFFICER)
(216) 445-1343
Entity
Organization
Contact information
Practice address
200 SE HOSPITAL AVE, STUART, FL 34994-2346
(772) 223-2832
(772) 781-2716
Mailing address
6801 BRECKSVILLE RD, STE 20 ATTN: DPC RK2-7, INDEPENDENCE, OH 44131-5062
(216) 636-4969
(216) 636-6063
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
208D00000X
General Practice Physician
—
FL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377282900
—
FL
05
—
377282901
—
FL
05
—
377282903
—
FL
05
—
377282906
—
FL
05
—
377282907
—
FL
05
—
377282912
—
FL
05
—
377282913
—
FL
05
—
377282917
—
FL
05
—
377282920
—
FL
05
—
377282921
—
FL
01
—
CC6070
RR MEDICARE
FL
Enumeration date
06/10/2006
Last updated
08/08/2025
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