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General NPI Number Information
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NPI Number | 1124419668
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Entity Type | Organization
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Legal Business Name | HARDIN COUNTY PRIMARY CARE PLLC
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 912 WOODLAND DR SUITE B
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2795
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Country | US
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Telephone | 270-765-5112
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Fax | 270-737-9252
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Provider Business Mailing Address
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Address Line | 912 WOODLAND DR SUITE B
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2795
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Country | US
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Telephone | 270-765-5112
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Fax | 270-737-9252
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHENDRA M PATEL
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Credential | MD
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Telephone | 270-765-5112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 17871
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License Number State | KY
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