1780757260 NPI number — DR. ANTHONY HART D.C.

Table of content: DR. ANTHONY HART D.C. (NPI 1780757260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780757260 NPI number — DR. ANTHONY HART D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1780757260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2331 108TH LN NE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BLAINE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55449-5268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-253-7777
Provider Business Mailing Address Fax Number:
763-253-7779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2331 108TH LN NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-253-7777
Provider Business Practice Location Address Fax Number:
763-253-7779
Provider Enumeration Date:
11/15/2006

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: 111N00000X , with the licence number:  3024 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3C237HA . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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