Provider Demographics
NPI:1548538002
Name:LEWIS HARGETT MD PSC
Entity type:Organization
Organization Name:LEWIS HARGETT MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYISICAN
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-366-8021
Mailing Address - Street 1:1900 BLUEGRASS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1144
Mailing Address - Country:US
Mailing Address - Phone:502-366-8021
Mailing Address - Fax:502-366-8235
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1144
Practice Address - Country:US
Practice Address - Phone:502-366-8021
Practice Address - Fax:502-366-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038361A208100000X
KYKY26076208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64260763Medicaid
KY1587501Medicare PIN
IN244240Medicare PIN