Healthcare Provider Details

I. General information

NPI: 1568409605
Provider Name (Legal Business Name): JAMES M HARDWICK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CHARLES ST
DEADWOOD SD
57732-1303
US

IV. Provider business mailing address

1601 N HARRISON AVE
PIERRE SD
57501-2378
US

V. Phone/Fax

Practice location:
  • Phone: 605-722-6101
  • Fax:
Mailing address:
  • Phone: 605-945-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0432
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: