Provider Demographics
NPI:1114185212
Name:LESLIE C. HARDICK DO, PA
Entity Type:Organization
Organization Name:LESLIE C. HARDICK DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HARDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-924-2216
Mailing Address - Street 1:1325 PENNSYLVANIA AVE STE 690
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2133
Mailing Address - Country:US
Mailing Address - Phone:817-924-2216
Mailing Address - Fax:817-924-5602
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 690
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2133
Practice Address - Country:US
Practice Address - Phone:817-924-2216
Practice Address - Fax:817-924-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty