Provider Demographics
NPI:1245313246
Name:VARGO ENTERPRISES INC
Entity type:Organization
Organization Name:VARGO ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:CLS
Authorized Official - Phone:859-987-1665
Mailing Address - Street 1:2017 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361
Mailing Address - Country:US
Mailing Address - Phone:859-987-1665
Mailing Address - Fax:859-987-3064
Practice Address - Street 1:2017 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361
Practice Address - Country:US
Practice Address - Phone:859-987-1665
Practice Address - Fax:859-987-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200122291U00000X
KY8962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37902483Medicaid
KY86000916Medicaid
KY4003101Medicare UPIN
KY9361501Medicare ID - Type UnspecifiedX-RAY
KY86000916Medicaid
KY37902483Medicaid