Provider Demographics
NPI:1932280542
Name:HARTMAN COMMUNITY CLINIC PA
Entity Type:Organization
Organization Name:HARTMAN COMMUNITY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-241-9600
Mailing Address - Street 1:4250 FIVE POINTS RD
Mailing Address - Street 2:STE 14
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-4511
Mailing Address - Country:US
Mailing Address - Phone:361-241-9600
Mailing Address - Fax:361-241-9605
Practice Address - Street 1:103 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2604
Practice Address - Country:US
Practice Address - Phone:361-547-3203
Practice Address - Fax:361-547-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160141102Medicaid
TX160141101Medicaid
TX673861Medicare Oscar/Certification