Provider Demographics
NPI:1477587921
Name:BARNHART, HENRY TRENT (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:TRENT
Last Name:BARNHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:TRENT
Other - Last Name:BARNHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:698 FEATHERSTONE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6303
Mailing Address - Country:US
Mailing Address - Phone:815-399-4404
Mailing Address - Fax:815-484-7091
Practice Address - Street 1:698 FEATHERSTONE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6303
Practice Address - Country:US
Practice Address - Phone:815-399-4404
Practice Address - Fax:815-484-7091
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL834370OtherMEDICARE GROUP #
IL036066769Medicaid
IL553180OtherMEDICARE GROUP #
ILL37110Medicare ID - Type Unspecified
IL553180003Medicare PIN
ILD89958Medicare UPIN
IL834330Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILCC5050Medicare ID - Type UnspecifiedRR MEDICARE GROUP #
IL553180OtherMEDICARE GROUP #
IL080051432Medicare ID - Type UnspecifiedRR INDIVIDUAL #
IL036066769Medicaid
IL834340002Medicare PIN
ILR01415Medicare PIN