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General NPI Number Information
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NPI Number | 1689714669
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Entity Type | Individual
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Provider Name | LONNIE BARGO
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 420 STILESVILLE RD
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City | SCIENCE HILL
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State | KY
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Zip | 42553-7410
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Country | US
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Telephone | 606-451-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 39 BOLTON DR
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City | SOMERSET
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State | KY
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Zip | 42503-4910
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Country | US
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Telephone | 606-875-8576
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Fax | 606-875-8576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 49038
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License Number State | KY
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