1609949403 NPI number — HARTVILLE MEDICAL CENTER INC

Table of content: (NPI 1609949403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609949403 NPI number — HARTVILLE MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARTVILLE MEDICAL CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609949403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 S SCHOOL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65667-8406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-741-7484
Provider Business Mailing Address Fax Number:
417-741-7482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 S SCHOOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-741-7484
Provider Business Practice Location Address Fax Number:
417-741-7482
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BERNER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
989-892-7722

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 508308202 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".