=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801006986
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAPIDS FOOT CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 01/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 8TH ST S
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-423-8637
-----------------------------------------------------
Fax | 715-424-2724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 8TH ST S
-----------------------------------------------------
City | WISCONSIN RAPIDS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54494-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-423-8637
-----------------------------------------------------
Fax | 715-424-2724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. PATRIC J. HARDIMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-423-8637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 678-025
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------