Healthcare Provider Details

I. General information

NPI: 1356484703
Provider Name (Legal Business Name): HARGRODER MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 HIGHWAY 190 STE X
EUNICE LA
70535-5129
US

IV. Provider business mailing address

PO BOX 407
CHURCH POINT LA
70525-0407
US

V. Phone/Fax

Practice location:
  • Phone: 337-580-7544
  • Fax: 337-580-7621
Mailing address:
  • Phone: 337-684-5232
  • Fax: 337-684-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number020601
License Number StateLA

VIII. Authorized Official

Name: DR. TY GLENN HARGRODER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 337-684-5232