1821155417 NPI number — DR. JAMES I HART OD

Table of content: DR. JAMES I HART OD (NPI 1821155417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821155417 NPI number — DR. JAMES I HART OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
JAMES
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1821155417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 W HENDERSON
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEBURNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-774-9800
Provider Business Mailing Address Fax Number:
817-556-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 HWY 377 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-279-0558
Provider Business Practice Location Address Fax Number:
817-573-2450
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1904 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38775 . This is a "SUPERIOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 024932 . This is a "LOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47721 . This is a "DAVIS INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 919802 . This is a "BLOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 228 . This is a "WALMART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 454333 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 580627 . This is a "BC & BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 979802 . This is a "BLOCK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23573 . This is a "SPECTERA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 371 . This is a "WALMART" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019246 . This is a "LOC" identifier . This identifiers is of the category "OTHER".




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