Provider Demographics
NPI:1972508869
Name:BARDGETT, JAMES F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:BARDGETT
Suffix:JR
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1600
Mailing Address - Fax:859-344-0091
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0690864Medicaid
KY7100056850Medicaid
IN200011140Medicaid
KYP00629647OtherRAILROAD MEDICARE
KY64257603Medicaid
KYP01040068OtherRAILROAD MEDICARE
KYP00629647OtherRAILROAD MEDICARE
KY0969406Medicare PIN
OHH097850Medicare PIN
KY64257603Medicaid
KY1459524Medicare PIN
KYA82886Medicare UPIN
IN200011140Medicaid
KYP00629647Medicare PIN
OH0690864Medicaid
KYP00245815Medicare PIN
KYP01040068OtherRAILROAD MEDICARE