Provider Demographics
NPI:1215089826
Name:HARTWELL FAMILY PRACTICE
Entity type:Organization
Organization Name:HARTWELL FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-346-4234
Mailing Address - Street 1:190 E MESQUITE BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027
Mailing Address - Country:US
Mailing Address - Phone:702-346-4234
Mailing Address - Fax:702-346-4236
Practice Address - Street 1:190 E MESQUITE BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027
Practice Address - Country:US
Practice Address - Phone:702-346-4234
Practice Address - Fax:702-346-4236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty