Kenneth R Pendergrast (NPI# 1255304697, PAC ID# 7719073410) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1255304697 |
| PAC ID by PECOS | 7719073410 |
| Professional Enrollment ID | I20100806000387 |
| Full Name | Kenneth R Pendergrast |
| Organization Legal Name | KINGSFORD PHYSICIAN SERVICES LLC |
| Address |
2400 Lee Hwy N Pulaski VA 24301-2326 |
| Phone Number | 5409948100 |
| Gender | M |
| Medical School | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT |
| Graduation Year | 1987 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 0840541017 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490048 | LEWISGALE MEDICAL CENTER |
| 490116 | LEWISGALE HOSPITAL PULASKI |
| 490110 | LEWISGALE HOSPITAL MONTGOMERY |
| Address | Phone | Organization |
|---|---|---|
| 2400 Lee Hwy N, Pulaski, VA 24301-2326 | 5409948100 | KINGSFORD PHYSICIAN SERVICES LLC |
| 1802 Braeburn Dr, Salem, VA 24153-7357 | 5407723400 | LEWIS GALE PHYSICIANS LLC |
| 1900 Electric Rd, Salem, VA 24153-7474 | 5407764000 | LAKE SPRING PHYSICIAN SERVICES, LLC |
| 2155 Apperson Dr, Salem, VA 24153-7235 | 5404442010 | LEWIS GALE PHYSICIANS LLC |
| Organization Legal Name | KINGSFORD PHYSICIAN SERVICES LLC |
| Physicians | 15 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anthony G Patriarco | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Brandon Warren Johnson | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Angela P Blackman | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Aja S Buhler | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Melanie M Hudgins | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Saddam Ehsan Zaidi | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Feras J Ghosheh | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Christy Fagg | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| David Daniel Bradley | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Erica A Waddle | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Street Address |
2400 LEE HWY N |
| City | PULASKI |
| State | VA |
| Zip | 24301-2326 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joseph D Cacioppo | Emergency Medicine | Kingsford Emergency Group, LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Anthony G Patriarco | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Brandon Warren Johnson | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Bita Mansouri | Emergency Medicine | Kingsford Emergency Group, LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Benjamin S Davidson | Emergency Medicine | Kingsford Emergency Group, LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Angela P Blackman | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Alexander Fernandez | Certified Registered Nurse Anesthetist (crna) | Pulaski Community Hospital Inc | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Aja S Buhler | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Melanie M Hudgins | Nurse Practitioner | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Saddam Ehsan Zaidi | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Andrea W Rupe | Nurse Practitioner | 101 1st Nwst, Suite 2, Pulaski, VA 24301 | |
| Karanita M Ojomo | Radiation Oncology | Oncology and Hematology Associates of Southwest Virginia, Inc. | 2400 Lee N Hwy, Pulaski, VA 24301-2326 |
| Feras J Ghosheh | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| J Frederick Hyduke | Anesthesiology | 2400 Lee Hwy N, Pulaski, VA 24301-2326 | |
| Owen W Roberts | Hematology/oncology | Lewis Gale Physicians LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Christy Fagg | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| David Daniel Bradley | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Erica A Waddle | Internal Medicine | Kingsford Physician Services LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Jane S Weiseman | Emergency Medicine | Kingsford Emergency Group, LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Scott A Wright | Internal Medicine | Kingsford Emergency Group, LLC | 2400 Lee Hwy N, Pulaski, VA 24301-2326 |
| Find all physicians in zip 24301 | |||
| City | PULASKI |
| Zip Code | 24301 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | PULASKI + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Kenneth R Pendergrast.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.