Provider Demographics
NPI:1326539925
Name:HARTMAN PEDIATRICS, LLC
Entity Type:Organization
Organization Name:HARTMAN PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:309-249-0069
Mailing Address - Street 1:3061 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5903
Mailing Address - Country:US
Mailing Address - Phone:309-249-0069
Mailing Address - Fax:309-524-4654
Practice Address - Street 1:3061 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5903
Practice Address - Country:US
Practice Address - Phone:309-249-0069
Practice Address - Fax:309-524-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135186-ILMedicaid