MEDICARE: HOLLIS DIANE HARDMAN M.A., FAAA

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
1	231H00000X	Audiologist	51188	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00660201	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1780835710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIS DIANE HARDMAN M.A., FAAA

Provider Business Mailing Address
First Line	:	P.O. BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-332-2304

Provider Business Practice Location Address
First Line	:	901 HEMPHILL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-0000
Country	:	US
Telephone Number	:	817-332-4060
Fax Number	:	817-332-2304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	02/18/2010

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