Provider Demographics
NPI:1245541184
Name:HARGIS, TRAVIS D (PA-C)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:D
Last Name:HARGIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8402 HARCOURT RD STE 125
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2094
Mailing Address - Country:US
Mailing Address - Phone:173-802-2000
Mailing Address - Fax:317-802-3972
Practice Address - Street 1:8402 HARCOURT RD STE 125
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2094
Practice Address - Country:US
Practice Address - Phone:173-802-2000
Practice Address - Fax:317-802-3972
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001181A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201117310Medicaid
IN9433669OtherAETNA
IN000000870334OtherANTHEM
IN000000870334OtherANTHEM