Provider Demographics
NPI:1053370916
Name:HART MARKETING
Entity type:Organization
Organization Name:HART MARKETING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-207-2670
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46130-0191
Mailing Address - Country:US
Mailing Address - Phone:800-207-2670
Mailing Address - Fax:317-713-7100
Practice Address - Street 1:449 E BROOKVILLE RD
Practice Address - Street 2:
Practice Address - City:FOUNTAINTOWN
Practice Address - State:IN
Practice Address - Zip Code:46130-9526
Practice Address - Country:US
Practice Address - Phone:800-207-2670
Practice Address - Fax:317-713-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200504870Medicaid
000000365675OtherANTHEM
7102000IN46130OtherBC/BS
5370290001Medicare NSC