Healthcare Provider Details

I. General information

NPI: 1710913033
Provider Name (Legal Business Name): HARDIN PHYSICIAN FOUNDATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E FRANKLIN ST
KENTON OH
43326-2020
US

IV. Provider business mailing address

L 3309
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-673-0761
  • Fax:
Mailing address:
  • Phone: 800-514-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34008871
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35075560
License Number StateOH

VIII. Authorized Official

Name: MARK SECKINGER
Title or Position: SECRETARY
Credential:
Phone: 419-675-8318