Provider Demographics
NPI:1205164209
Name:JAMES L. HARTJE M.D. P.C.
Entity type:Organization
Organization Name:JAMES L. HARTJE M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:HARTJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-255-5835
Mailing Address - Street 1:2730 PIERCE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-255-5835
Mailing Address - Fax:712-234-1140
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-255-5835
Practice Address - Fax:712-234-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0158881Medicaid
IA0158881Medicaid
IA0158881Medicaid
IA15888Medicare PIN