MEDICARE: SARA L HARTSAW MD

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	208600000X	Surgery Physician	4519A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881691905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA L HARTSAW MD

Provider Business Mailing Address
First Line	:	PO BOX 1272
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82717-1272
Country	:	US
Telephone Number	:	307-682-7555
Fax Number	:	307-687-7243

Provider Business Practice Location Address
First Line	:	3100 W LAKEWAY RD STE 1
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6373
Country	:	US
Telephone Number	:	307-682-7555
Fax Number	:	307-687-7243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/28/2020

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Directions to “ SARA L HARTSAW MD” Practice Location

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