Provider Demographics
NPI:1699295055
Name:HARGIS PEDIATRIC THERAPY, L.L.C
Entity type:Organization
Organization Name:HARGIS PEDIATRIC THERAPY, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:903-277-8039
Mailing Address - Street 1:558 MADISON 8593
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-9326
Mailing Address - Country:US
Mailing Address - Phone:903-277-8039
Mailing Address - Fax:479-738-2070
Practice Address - Street 1:815 N GASKILL ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-8968
Practice Address - Country:US
Practice Address - Phone:903-277-8039
Practice Address - Fax:479-738-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3333261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199958721Medicaid