Basic Information
| Provider Information | |||||||||
| NPI: | 1437102613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDWICK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5751 KUAKINI HIGHWAY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263878 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 75-5751 KUAKINI HWY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263878 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD 343 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 19602 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 016105 | 05 | AZ | MEDICAID |