Provider Demographics
NPI:1568409605
Name:HARDWICK, JAMES M (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HARDWICK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2378
Mailing Address - Country:US
Mailing Address - Phone:605-945-1710
Mailing Address - Fax:
Practice Address - Street 1:61 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:SD
Practice Address - Zip Code:57732-1303
Practice Address - Country:US
Practice Address - Phone:605-722-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6824182Medicaid
SD9238019OtherDAKOTACARE
SD0040959OtherWELLMARK
SD6824182Medicaid
P03111Medicare UPIN