Provider Demographics
NPI:1770734956
Name:RAVINDER S. BHAGRATH M.D. PSC
Entity type:Organization
Organization Name:RAVINDER S. BHAGRATH M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHAGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-9456
Mailing Address - Street 1:255 CHURCH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3476
Mailing Address - Country:US
Mailing Address - Phone:606-432-9456
Mailing Address - Fax:606-432-2140
Practice Address - Street 1:255 CHURCH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-432-9456
Practice Address - Fax:606-432-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64030091Medicaid
KY64030091Medicaid