1851482475 NPI number — DR. THOMAS G HARTMANN MD

Table of content: DR. THOMAS G HARTMANN MD (NPI 1851482475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851482475 NPI number — DR. THOMAS G HARTMANN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTMANN
Provider First Name:
THOMAS
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1851482475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12467 MATTHEWS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-842-3943
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 DOUGHERTY FERRY RD
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63122-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-966-9666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

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: 207P00000X , with the licence number:  R9107 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 930024415 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012050155 . This is a "CPIN ST ANTHONYS" identifier . This identifiers is of the category "OTHER".




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