Provider Demographics
NPI:1235133083
Name:HARDCASTLE, SAMUEL F (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:F
Last Name:HARDCASTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PARK ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1760
Mailing Address - Country:US
Mailing Address - Phone:270-796-6540
Mailing Address - Fax:270-796-6576
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:SUITE 6B
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-745-1467
Practice Address - Fax:270-745-1156
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64341357Medicaid
KY64341357Medicaid
KYG86522Medicare UPIN