Provider Demographics
NPI:1609949403
Name:HARTVILLE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HARTVILLE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-7722
Mailing Address - Street 1:275 S SCHOOL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65667-8406
Mailing Address - Country:US
Mailing Address - Phone:417-741-7484
Mailing Address - Fax:417-741-7482
Practice Address - Street 1:275 S SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:MO
Practice Address - Zip Code:65667
Practice Address - Country:US
Practice Address - Phone:417-741-7484
Practice Address - Fax:417-741-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO508308202Medicaid