1366439127 NPI number — DR. VANESSA MARIE HART MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366439127 NPI number — DR. VANESSA MARIE HART MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
VANESSA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HART
Provider Other First Name:
VANESSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, FACS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366439127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6443 BUSINESS PARK LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84098-6272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-901-4334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6443 BUSINESS PARK LOOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84098-6272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-200-9075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2005

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: 208600000X , with the licence number:  7355233-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 267795400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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