Provider Demographics
NPI:1497945877
Name:JACK F. HARDWICK,M.D.,P.A.
Entity Type:Organization
Organization Name:JACK F. HARDWICK,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-346-5330
Mailing Address - Street 1:7100 OAKMONT BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3900
Mailing Address - Country:US
Mailing Address - Phone:817-346-5330
Mailing Address - Fax:817-346-5356
Practice Address - Street 1:7100 OAKMONT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3900
Practice Address - Country:US
Practice Address - Phone:817-346-5330
Practice Address - Fax:817-346-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L48VMedicare PIN
TXC16586Medicare UPIN