Healthcare Provider Details

I. General information

NPI: 1801072442
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: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 NORTH PINE RD
OLLA LA
71465
US

IV. Provider business mailing address

1102 NORTH PINE RD
OLLA LA
71465
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number200484
License Number StateLA

VIII. Authorized Official

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