Basic Information
| Provider Information | |||||||||
| NPI: | 1104853050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1500 | ||||||||
| Address2: | |||||||||
| City: | OSAGE BEACH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65065 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2333 HIGHWAY 17 | ||||||||
| Address2: | |||||||||
| City: | IBERIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737936900 | ||||||||
| FaxNumber: | 5737936688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 02/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 086955 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 086955 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 135570018 | 01 | MO | MEDICARE PTAN | OTHER | 100028070A | 05 | OK | MEDICAID | 428676803 | 05 | MO | MEDICAID | 100301480A | 05 | KS | MEDICAID | P00780874 | 01 | MO | RAILROAD MEDICAID | OTHER |