Provider Demographics
NPI:1417005893
Name:HART, MATTHEW EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EUGENE
Last Name:HART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEALTH WAY DR
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1420
Mailing Address - Country:US
Mailing Address - Phone:573-438-5451
Mailing Address - Fax:573-438-2399
Practice Address - Street 1:300 HEALTH WAY DR
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1420
Practice Address - Country:US
Practice Address - Phone:573-438-5451
Practice Address - Fax:573-438-5791
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODO106076208D00000X, 207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080139721OtherRAILROAD MEDICARE
431845485OtherGREAT WEST LIFE
431845485OtherCENTURY PLANNERS
431845485OtherFIRST HEALTH
58275OtherGROUP HEALTH PLAN
431845485OtherPRINCIPAL HEALTH CARE
431845485OtherAMERICAN POSTAL WORKERS
431845485OtherGENERAL AMERICAN LIFE
MO117150OtherBLUE CROSS
431845485OtherCIGNA
0107110OtherUNITED HEALTHCARE
1680V19251OtherHEALTHCARE USA
G18560OtherMERCY HEALTH PLAN
220102500OtherDEPT OF LABOR
MO248086027Medicaid
331383OtherHEALTHLINK
431845485OtherHUMANA
798170OtherHEALTH PARTNERS
MO002013109Medicare ID - Type Unspecified
MO248086027Medicaid