Basic Information
| Provider Information | |||||||||
| NPI: | 1568409605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDWICK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 N HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | PIERRE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575012378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059451710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | DEADWOOD | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577321303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057226101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 02/23/2008 | ||||||||
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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 | 0432 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 6824182 | 05 | SD | MEDICAID | 9238019 | 01 | SD | DAKOTACARE | OTHER | 0040959 | 01 | SD | WELLMARK | OTHER |