Healthcare Provider Details

I. General information

NPI: 1952514549
Provider Name (Legal Business Name): TAMMY HART, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N FULLERTON ST
PRINCETON MO
64673-1418
US

IV. Provider business mailing address

400 N FULLERTON ST
PRINCETON MO
64673-1418
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-4040
  • Fax: 660-748-4042
Mailing address:
  • Phone: 660-748-4040
  • Fax: 660-748-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number100333
License Number StateMO

VIII. Authorized Official

Name: TAMMY K HART
Title or Position: PRESIDENT
Credential: M.D.
Phone: 660-748-4040