Basic Information
| Provider Information | |||||||||
| NPI: | 1295711760 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | KIRBY | ||||||||
| MiddleName: | LAMAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2431 W MAIN ST | ||||||||
| Address2: | STE 501 | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363011217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347939222 | ||||||||
| FaxNumber: | 3346710322 | ||||||||
| Practice Location | |||||||||
| Address1: | 2431 W MAIN ST | ||||||||
| Address2: | STE 501 | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363011217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347939222 | ||||||||
| FaxNumber: | 3346710322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2005 | ||||||||
| LastUpdateDate: | 06/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | AL07069 | AL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 12233 | 01 | COVENTRY HEALTH CARE | OTHER | 00488617A | 05 | GA | MEDICAID | 102I168271 | 01 | PTAN | OTHER | 511-17846 | 01 | AL | BCBSAL LOCATION ID NUMBER | OTHER | 7410413 | 01 | UNITED HEALTHCARE | OTHER | 7207217 | 01 | CIGNA | OTHER | 046793600 | 05 | FL | MEDICAID | 00010721 | 05 | AL | MEDICAID |