NPIMap

Organization Active NPI

Lasalle Parish Hospital Service District #1

Doing business as Hardtner Medical Clinic

  • Rural Health Clinic/Center
  • Olla, LA
National Provider Identifier
1053415745
Registry record updated Apr 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
178RHC-1 Issued in LA
Legal business name
LASALLE PARISH HOSPITAL SERVICE DISTRICT #1
Doing business as
Hardtner Medical Clinic
Practice address
1049 North Pine Road
Olla, LA 71465
Phone
(318) 495-3880
Fax
(318) 495-3882
NPI assigned
Sep 12, 2006
Last updated
Apr 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul G Mathews
Title
Administrator
Phone
(318) 495-3131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 178RHC-1 LA Primary

Addresses

Primary practice location

1049 North Pine Road
Olla, LA 71465

Mailing address

1049 N Pine Rd
Olla, LA 71465-4826
Phone (318) 495-3880

Other identifiers 1

IdentifierTypeStateIssuer
1449342MedicaidLA

Other names 1

  • HARDTNER MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040408000438 LA Part B Supplier - Clinic/Group Practice 6709781545 Receives reassigned benefits from 76 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Olla, LA
O20050217000920 LA Part A Provider - Rural Health Clinic 6709781545 Practice locations: Olla, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053415745. Details of each certification follow.

Rural health clinic certification: CCN 193456

Legal name
LASALLE PARISH HOSPITAL SERVICE DIST NO1
Doing business as
HARDTNER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 11, 2005
Last certification
Aug 31, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1049 North Pine Road
Olla, LA 71465-4805
Related CCNs
191315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1019288Hardtner Medical Clinic1049 North Pine Road, Olla, LA 71465Provider-performed microscopyNov 13, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lasalle Hospital Service District 18 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1136 Pine St
#A
Olla, LA 71465

1136A Pine St
Olla, LA 71465
Phone (318) 495-3880

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Steve Tannehill Individual Corporate DirectorBoard Member Aug 12, 2013
Other Aug 21, 2014
Rick Smotherman Individual Corporate DirectorBoard Member Nov 14, 2005
Other Nov 14, 2005
Michael Duke Individual Corporate DirectorBoard Member Jan 1, 2003
Other Jan 1, 2013
Steven Richardson Individual Corporate Officer Jan 1, 2025
Lyle J Ivy Individual Corporate Officer Jan 1, 2025
Cherry Salter Individual W-2 Managing Employee Sep 19, 2014
OtherDirector of Nurses/RN Sep 19, 2014
Paul Mathews Individual Corporate OfficerCeo Jul 1, 2001
W-2 Managing EmployeeCeo - Board Member Jul 1, 2001
Other Jul 5, 2001
Leann Cupples Individual W-2 Managing EmployeeHR Director/Exec Asst Sep 19, 2014
OtherHR Director/Exec Asst Dec 1, 2001

Practitioners & affiliated clinicians

Practitioners 70

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 70

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1053415745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1049 N PINE RD",
            "city": "OLLA",
            "state": "LA",
            "postal_code": "714654826",
            "telephone_number": "318-495-3880",
            "fax_number": "318-495-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1049 NORTH PINE ROAD",
            "city": "OLLA",
            "state": "LA",
            "postal_code": "71465",
            "telephone_number": "318-495-3880",
            "fax_number": "318-495-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASALLE PARISH HOSPITAL SERVICE DISTRICT #1",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "MATHEWS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-495-3131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "LA",
            "license": "178RHC-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1449342",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARDTNER MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HARDTNER MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olla, LA

Sources for this page

Verify at the official NPI Registry.