Provider Demographics
NPI:1982947974
Name:KEVIN G HARTMAN ESTATE
Entity Type:Organization
Organization Name:KEVIN G HARTMAN ESTATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-636-1911
Mailing Address - Street 1:816 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4092
Mailing Address - Country:US
Mailing Address - Phone:423-636-1911
Mailing Address - Fax:423-798-9962
Practice Address - Street 1:816 TUSCULUM BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4092
Practice Address - Country:US
Practice Address - Phone:423-636-1911
Practice Address - Fax:423-798-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4344722OtherBCBS