Provider Demographics
NPI:1952345795
Name:SAM HAWATMEH, M D, P C
Entity Type:Organization
Organization Name:SAM HAWATMEH, M D, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAWATMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-645-8200
Mailing Address - Street 1:6651 CHIPPEWA ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2538
Mailing Address - Country:US
Mailing Address - Phone:314-645-8200
Mailing Address - Fax:314-645-8244
Practice Address - Street 1:6651 CHIPPEWA ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2538
Practice Address - Country:US
Practice Address - Phone:314-645-8200
Practice Address - Fax:314-645-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1125337OtherFIRST HORIZON
MO125694OtherHEALTHLINK
MO178V178OtherGHP
MOCG6708OtherRRMCR
MO178V178OtherCMR
MO305572OtherPARTNER HMO
MOSTM040053OtherMEDICAL COMP
MO1140267OtherCARE PARTNER
MO4039765OtherAETNA
MO507424406Medicaid
MOE31401OtherMERCY
MO55772OtherHEALTHCARE
MOPC23505OtherCIGNA
MOSTL040029OtherUNITED HEALTHCARE
MO26810OtherBLUE
MO26810OtherBLUE CHOICE
MO889041OtherCOMMUNITY
MOE31401OtherMERCY