Basic Information
| Provider Information | |||||||||
| NPI: | 1013917780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARTON MEDICAL CLINIC PLLC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553874552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
| FaxNumber: | 9524423620 | ||||||||
| Practice Location | |||||||||
| Address1: | 614 N MARTIN ST | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716711904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702266580 | ||||||||
| FaxNumber: | 8702266554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 04/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARTON | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8702266580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E3166 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5C908 | 01 | AR | BLUE CROSS OF AR | OTHER | 150670002 | 05 | AR | MEDICAID |