Healthcare Provider Details

I. General information

NPI: 1689636698
Provider Name (Legal Business Name): JOHN J HART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E RANDALL ST
HESSTON KS
67062
US

IV. Provider business mailing address

PO BOX 308
NEWTON KS
67114
US

V. Phone/Fax

Practice location:
  • Phone: 620-327-2440
  • Fax: 620-327-2062
Mailing address:
  • Phone: 316-283-2700
  • Fax: 316-804-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-19352
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100112760B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: