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NPI Code Detail

MEDICARE: BOBBY RICHARD HARDY H.I.S.

MEDICARE: BOBBY RICHARD HARDY H.I.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237700000XHearing Instrument Specialist658TN
2237700000XHearing Instrument Specialist546MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11B4080841OTHERTNTENNESSEE BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number : 1649584897
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY RICHARD HARDY H.I.S.
Provider Business Mailing Address
First Line : 888 COUNTY ROAD 115
Second Line :
City : NEW ALBANY
State : MS
Zip : 38652-9518
Country : US
Telephone Number : 731-668-3165
Fax Number : 731-668-9860
Provider Business Practice Location Address
First Line : 2021 GREYSTONE SQ
Second Line :
City : JACKSON
State : TN
Zip : 38305-3576
Country : US
Telephone Number : 731-668-3165
Fax Number : 731-668-9860
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2010
Last Update Date : 07/29/2010

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