1316149578 NPI number — MR. WILLIAM MCDONALD HARDY JR. MSPA-C

Table of content: MR. WILLIAM MCDONALD HARDY JR. MSPA-C (NPI 1316149578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316149578 NPI number — MR. WILLIAM MCDONALD HARDY JR. MSPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDY
Provider First Name:
WILLIAM
Provider Middle Name:
MCDONALD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSPA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316149578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 ANDERSON COUNTY ROAD 2139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-731-4307
Provider Business Mailing Address Fax Number:
903-731-4307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PALESTINE REGIONAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2900 SOUTH LOOP 256
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-723-0911
Provider Business Practice Location Address Fax Number:
903-723-0999
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA01693 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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