NPIMap

Individual provider Active NPI

Justin Coleman Hardin, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Longview, TX
National Provider Identifier
1124252796
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
P6631 Issued in TX
Practice address
707 Hollybrook Dr
Longview, TX 75605-2410
Phone
(903) 757-6042
Fax
(903) 232-8226
NPI assigned
May 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) Physician 207ZD0900X P6631 TX
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X P6631 TX Primary

Addresses

Primary practice location

707 Hollybrook Dr
Longview, TX 75605-2410

Mailing address

PO Box 610393
Dallas, TX 75261-0393
Phone (903) 291-6187

Other identifiers 1

IdentifierTypeStateIssuer
340288502MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, LA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141112002218 TX Practitioner - Pathology 9133341894 Reassigns benefits to 1 organization
I20191025001850 LA Practitioner - Pathology 9133341894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Texas Tech University Health Science Center School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Clinicians of East TexasGroup PAC ID 4789957440, 106 clinicians

Practice addresses (Care Compare)

5339 Odonovan Dr
Baton Rouge, LA 70808-4388
Phone (225) 766-4999

707 Hollybrook Dr
Longview, TX 75605-2410
Phone (903) 291-6161

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
P6631TXMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Clinicians of East Texas Anatomic Pathology & Clinical Pathology CurrentSince Sep 1, 2017 Accepting new patients
Pathology Group of Louisiana, a Professional Medical Corporation Dermatopathology CurrentSince Jun 20, 2019 Accepting new patients
Pathology Group of Louisiana, a Professional Medical Corporation Anatomic Pathology & Clinical Pathology CurrentSince Jun 20, 2019 Accepting new patients
Associated Clinicians of East Texas Past Accepting new patients

Locations

5339 Odonovan Dr
Baton Rouge, LA 70808
Phone (225) 766-4999

707 Hollybrook Dr
Bldg 1
Longview, TX 75605

1009 N 4th St
Ste A
Longview, TX 75601
Phone (903) 757-3808

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

707 Hollybrook Dr
Ste 500
Longview, TX 75605
Phone (903) 232-8276

707 Hollybrook Dr
Longview, TX 75605
Phone (903) 232-8501

707 Hollybrook Dr
Ste 400
Longview, TX 75605
Phone (903) 230-3223

Interoperability endpoints

  • Direct secure messaging: justin.hardin.1@23550.direct.athenahealth.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1124252796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 610393",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752610393",
            "telephone_number": "903-291-6187",
            "fax_number": "903-237-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 HOLLYBROOK DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052410",
            "telephone_number": "903-757-6042",
            "fax_number": "903-232-8226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDIN",
        "first_name": "JUSTIN",
        "middle_name": "COLEMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "TX",
            "license": "P6631",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "P6631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340288502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

Verify at the official NPI Registry.