MEDICARE: JOHN T HARDY M.D. P.C

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	251S00000X	Community/Behavioral Health Agency	30618	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962630939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN T HARDY M.D. P.C

Provider Business Mailing Address
First Line	:	1115 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2867
Country	:	US
Telephone Number	:	719-583-4232
Fax Number	:	719-562-4415

Provider Business Practice Location Address
First Line	:	1115 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2867
Country	:	US
Telephone Number	:	719-583-4232
Fax Number	:	719-562-4415

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOHN TUCKER HARDY
Credential	:	M.D.
Telephone Number	:	719-583-4232

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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