Provider Demographics
NPI:1326396797
Name:CHARLES E. HARDIN, JR. M.D.
Entity Type:Organization
Organization Name:CHARLES E. HARDIN, JR. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-349-1909
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0088
Mailing Address - Country:US
Mailing Address - Phone:606-349-1909
Mailing Address - Fax:606-349-1909
Practice Address - Street 1:787 PARKWAY DRIVE
Practice Address - Street 2:HARDIN MEDICAL PLAZA
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-0088
Practice Address - Country:US
Practice Address - Phone:606-349-1909
Practice Address - Fax:606-349-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227564Medicaid
KY7100177840Medicaid
1770862658Medicare PIN
C74889Medicare UPIN
KY64227564Medicaid