Provider Demographics
NPI:1932273604
Name:TW HARD MD AND ASSOCIATES
Entity Type:Organization
Organization Name:TW HARD MD AND ASSOCIATES
Other - Org Name:THE ORION MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD 'TED'
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-523-7222
Mailing Address - Street 1:3325 CHANATE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1707
Mailing Address - Country:US
Mailing Address - Phone:707-523-7222
Mailing Address - Fax:707-578-6840
Practice Address - Street 1:3116 W MARCH LN
Practice Address - Street 2:STE 200
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2369
Practice Address - Country:US
Practice Address - Phone:209-473-6555
Practice Address - Fax:209-473-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31017146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078340Medicaid
CAGR0078340Medicaid