Healthcare Provider Details

I. General information

NPI: 1245313246
Provider Name (Legal Business Name): VARGO ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 SOUTH MAIN
PARIS KY
40361
US

IV. Provider business mailing address

2017 SOUTH MAIN
PARIS KY
40361
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-1665
  • Fax: 859-987-3064
Mailing address:
  • Phone: 859-987-1665
  • Fax: 859-987-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number896
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number200122
License Number StateKY

VIII. Authorized Official

Name: MS. HENRIETTA RUTH GREY
Title or Position: LAB MANAGER
Credential: CLS
Phone: 859-987-1665