=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891859799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R V BHARNE PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 N HAYDEN AVENUE
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42078-0376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-988-3399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 376
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42078-0376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-988-3399
-----------------------------------------------------
Fax | 270-988-4059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF THE CORPORATION
-----------------------------------------------------
Name | DR. RAJENDRA V BHARNE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 270-988-3399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 18628
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------