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1093710675

NPI Code Detail

MEDICARE: HART FAMILY MEDICAL ASSOCIATES PC

MEDICARE: HART FAMILY MEDICAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	AB03370	MI
2	207Q00000X	Family Medicine Physician	5101011414	MI
3	207Q00000X	Family Medicine Physician	5101011554	MI
4	207Q00000X	Family Medicine Physician	5101009698	MI
5	207Q00000X	Family Medicine Physician	4101133105	MI
6	207Q00000X	Family Medicine Physician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3015197 TYPE 11	OTHER	MI	PAUL A WAGNER
2	8008974220	OTHER	MI	BCBS MI
3	500F4710070	OTHER	MI	BCBS NP GROUP NUMBER
4	01027	OTHER	MI	PRIORITY HEALTH GRP #
5	010F476090	OTHER	MI	BCBS GROUP NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	11272959	OTHER	MI	CAQH ID NUMBER
8	800F410320	OTHER	MI	BCBSMI

General Provider Information

NPI Number	:	1093710675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HART FAMILY MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	611 EAST MAIN ST
Second Line	:
City	:	HART
State	:	MI
Zip	:	49420-1190
Country	:	US
Telephone Number	:	231-873-5675
Fax Number	:	231-873-4805

Provider Business Practice Location Address
First Line	:	611 EAST MAIN ST
Second Line	:
City	:	HART
State	:	MI
Zip	:	49420-1190
Country	:	US
Telephone Number	:	231-873-5675
Fax Number	:	231-873-4805

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUDY C OCHS
Credential	:	DO
Telephone Number	:	231-873-5675

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	05/22/2009

Similar Medicare Providers

1811926744 — CYNTHIA OCHS DO
Practice Location Address:

611 E MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-5675
Practice Fax: 231-873-1825

1689605230 — ANN MARIE BLACKTOP LMSW
Practice Location Address:

611 E MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-5675
Practice Fax: 231-873-4805

1962434043 — PAUL A WAGNER DO
Practice Location Address:

611 EAST MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-5675
Practice Fax: 231-873-1825

1922030063 — RONALD E GRAESER DO
Practice Location Address:

611 E MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-5675
Practice Fax: 231-873-3448

1093816316 — DR. MIKE KOZMINSKI M.D.
Practice Location Address:

611 E MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-6900
Practice Fax: 231-873-1825

1972734200 — MERCY HEALTH PARTNERS
Practice Location Address:

611 E MAIN ST
HART, MI
49420-1190

Practice Phone: 231-873-5675
Practice Fax: 231-873-1825

Directions to “HART FAMILY MEDICAL ASSOCIATES PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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