Basic Information
| Provider Information | |||||||||
| NPI: | 1871788240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201B HIGHWAY 332 W STE 1300 | ||||||||
| Address2: | |||||||||
| City: | LAKE JACKSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775664033 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 201B HIGHWAY 332 W STE 1300 | ||||||||
| Address2: | |||||||||
| City: | LAKE JACKSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775664033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128580300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 03/02/2014 | ||||||||
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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 | 237700000X | 50477 | TX | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1770398-01 | 05 | TX | MEDICAID | 50477 | 01 | TX | SCFDHI | OTHER |