| John T Hardy M.d. P.c | |
|
1115 N Grand Ave Pueblo CO 81003-2867 | |
| (719) 583-4232 | |
| (719) 562-4415 |
| Full Name | John T Hardy M.d. P.c |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1115 N Grand Ave, Pueblo, Colorado |
| Authorized Official Name and Position | John Tucker Hardy (PHYSICIAN) |
| Authorized Official Contact | 7195834232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John T Hardy M.d. P.c 1115 N Grand Ave Pueblo CO 81003-2867 Ph: (719) 583-4232 | John T Hardy M.d. P.c 1115 N Grand Ave Pueblo CO 81003-2867 Ph: (719) 583-4232 |
| NPI Number | 1962630939 |
|---|---|
| Provider Enumeration Date | 06/29/2009 |
| Last Update Date | 06/29/2009 |
| Medicare PECOS PAC ID | 5092867036 |
|---|---|
| Medicare Enrollment ID | O20090722000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962630939 | NPI | - | NPPES |
| 01-306182 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 30618 (Colorado) | Primary |
| Provider Name | John T Hardy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619032182 PECOS PAC ID: 0547294662 Enrollment ID: I20050919000763 |
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