Provider Demographics
NPI:1073916623
Name:CARTHAGE CHILDREN'S CLINIC, LLC
Entity Type:Organization
Organization Name:CARTHAGE CHILDREN'S CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-359-9291
Mailing Address - Street 1:1221 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2028
Mailing Address - Country:US
Mailing Address - Phone:417-359-9291
Mailing Address - Fax:417-359-9241
Practice Address - Street 1:1221 OAK ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2028
Practice Address - Country:US
Practice Address - Phone:417-359-9291
Practice Address - Fax:417-359-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7F622080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty