Healthcare Provider Details

I. General information

NPI: 1588772636
Provider Name (Legal Business Name): BHARGAVA CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 LOCUST ST
LA CROSSE KS
67548-9673
US

IV. Provider business mailing address

PO BOX 490 817 LOCUST STREET
LA CROSSE KS
67548-0490
US

V. Phone/Fax

Practice location:
  • Phone: 785-222-2564
  • Fax: 785-222-2629
Mailing address:
  • Phone: 785-222-2564
  • Fax: 785-222-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHOK KUMAR BHARGAVA
Title or Position: PRESIDENT
Credential: MD
Phone: 785-222-2564