Active NPI
Jeffrey Thomas Hardwig
- Psychiatry Physician
- International Falls, MN
National Provider Identifier
1215969134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 30109
- Practice address
- 2501 Keenan Dr
International Falls, MN 56649-2181 - Phone
- (218) 283-9431
- Fax
- (218) 285-6275
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 30109 | MN | Primary |
Addresses
Primary practice location
2501 Keenan Dr
International Falls, MN 56649-2181
Mailing address
2501 Keenan Dr
International Falls, MN 56649-2181
Phone (218) 283-9431
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 709792100 | Medicaid | MN | |
| 32404300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30109 | MN | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215969134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 KEENAN DR",
"city": "INTERNATIONAL FALLS",
"state": "MN",
"postal_code": "566492181",
"telephone_number": "218-283-9431",
"fax_number": "218-285-6275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 KEENAN DR",
"city": "INTERNATIONAL FALLS",
"state": "MN",
"postal_code": "566492181",
"telephone_number": "218-283-9431",
"fax_number": "218-285-6275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARDWIG",
"first_name": "JEFFREY",
"middle_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "30109",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "709792100",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32404300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in International Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.