Basic Information
| Provider Information | |||||||||
| NPI: | 1649454257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDSEY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | HART | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAST MAIN STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975016041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417895516 | ||||||||
| FaxNumber: | 5417895518 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SW RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414727000 | ||||||||
| FaxNumber: | 9146826403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2007 | ||||||||
| LastUpdateDate: | 04/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 246453 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 246453 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 0433645 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.