Provider Demographics
NPI:1952514549
Name:TAMMY HART, MD, PC
Entity type:Organization
Organization Name:TAMMY HART, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-748-4040
Mailing Address - Street 1:400 N FULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MO
Mailing Address - Zip Code:64673-1418
Mailing Address - Country:US
Mailing Address - Phone:660-748-4040
Mailing Address - Fax:660-748-4042
Practice Address - Street 1:400 N FULLERTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MO
Practice Address - Zip Code:64673-1418
Practice Address - Country:US
Practice Address - Phone:660-748-4040
Practice Address - Fax:660-748-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100333261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO593909203Medicaid
MO240969OtherFREEDOM NETWORK
MO22235016OtherBCBS
MO240969OtherFREEDOM NETWORK
MO593909203Medicaid