Healthcare Provider Details

I. General information

NPI: 1013917780
Provider Name (Legal Business Name): HARTON MEDICAL CLINIC PLLC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N MARTIN ST
WARREN AR
71671-1904
US

IV. Provider business mailing address

400 E 10TH ST
WACONIA MN
55387-4552
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-6580
  • Fax: 870-226-6554
Mailing address:
  • Phone: 952-442-9770
  • Fax: 952-442-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3166
License Number StateAR

VIII. Authorized Official

Name: TIMOTHY S HARTON
Title or Position: OWNER
Credential: MD
Phone: 870-226-6580