Provider Demographics
NPI:1902072291
Name:BLUEGRASS BARIATRIC SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BLUEGRASS BARIATRIC SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSCHWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-543-1577
Mailing Address - Street 1:2716 OLD ROSEBUD RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8559
Mailing Address - Country:US
Mailing Address - Phone:859-543-1577
Mailing Address - Fax:859-543-1637
Practice Address - Street 1:2716 OLD ROSEBUD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8559
Practice Address - Country:US
Practice Address - Phone:859-543-1577
Practice Address - Fax:859-543-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35422208600000X
KY30697208600000X
KY42220208600000X
363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0765501Medicare UPIN
KY0765502Medicare UPIN
KY0765503Medicare UPIN