Provider Demographics
NPI:1588668172
Name:MEDICINE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:MEDICINE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-756-6438
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0857
Mailing Address - Country:US
Mailing Address - Phone:573-756-6438
Mailing Address - Fax:573-756-6439
Practice Address - Street 1:1103 WEBER RD
Practice Address - Street 2:STE 101
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3326
Practice Address - Country:US
Practice Address - Phone:573-756-6438
Practice Address - Fax:573-756-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12050Medicare ID - Type Unspecified