Healthcare Provider Details

I. General information

NPI: 1184800724
Provider Name (Legal Business Name): HARDTNER MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N PINE RD
OLLA LA
71465-4804
US

IV. Provider business mailing address

1102 N PINE RD
OLLA LA
71465-4804
US

V. Phone/Fax

Practice location:
  • Phone: 318-495-3131
  • Fax: 318-495-3346
Mailing address:
  • Phone: 318-495-3131
  • Fax: 318-495-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number06648R
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL G MATHEWS
Title or Position: CEO
Credential:
Phone: 318-495-3131