Provider Demographics
NPI:1881853265
Name:STEVEN C. APPLEGATE PSC
Entity Type:Organization
Organization Name:STEVEN C. APPLEGATE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CARSON
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-245-4174
Mailing Address - Street 1:11612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1318
Mailing Address - Country:US
Mailing Address - Phone:502-245-4174
Mailing Address - Fax:502-254-1372
Practice Address - Street 1:11612 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1318
Practice Address - Country:US
Practice Address - Phone:502-245-4174
Practice Address - Fax:502-254-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64226392Medicaid
KY64226392Medicaid
KY1518041862Medicare NSC
KY00646001Medicare PIN