Provider Demographics
NPI:1518254747
Name:TIMOTHY S. HART, MD, PSC
Entity Type:Organization
Organization Name:TIMOTHY S. HART, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-325-7500
Mailing Address - Street 1:933 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3021
Mailing Address - Country:US
Mailing Address - Phone:606-325-7500
Mailing Address - Fax:606-326-9136
Practice Address - Street 1:933 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3021
Practice Address - Country:US
Practice Address - Phone:606-325-7500
Practice Address - Fax:606-326-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007005261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care