Provider Demographics
NPI:1962594788
Name:R. LOWELL HARDCASTLE, MD PA
Entity type:Organization
Organization Name:R. LOWELL HARDCASTLE, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:HARDCASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-236-6948
Mailing Address - Street 1:1000 W KINGSHIGHWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4141
Mailing Address - Country:US
Mailing Address - Phone:870-236-6948
Mailing Address - Fax:870-236-7024
Practice Address - Street 1:1000 W KINGSHIGHWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4141
Practice Address - Country:US
Practice Address - Phone:870-236-6948
Practice Address - Fax:870-236-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0581690002OtherCIGNA GOVERNMENT SERVICES DURABLE MEDICAL EQUIPMENT REGION C
AR102560001Medicaid
MO500646203Medicaid
MO500646203Medicaid
AR5B035Medicare ID - Type Unspecified