Individual ProviderHarrison MartinNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140(260) 969-7280PECOS EnrollmentBased on the most recent information from CMS, provider Harrison Martin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1720704745Provider TypeIndividualFull NameMartin, HarrisonGenderMaleSole ProprietorNoEnumeration Date10/12/2022Last Updated1/26/2026Contact InformationPractice LocationPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140Phone(260) 969-7280Fax(260) 458-3461Mailing LocationMailing Address9321 Covington Woods Ct, Fort Wayne, IN 46804-7771PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71013155AIndiana