Individual
KENNETH R. HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-7200
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23585
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000475396
BCBS PIN - CHS, INC.
KY
05
—
6423585600
—
KY
01
—
P01367929
RAILROAD MEDICARE
KY
Enumeration date
03/31/2006
Last updated
12/04/2020
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