Provider Demographics
NPI:1902572993
Name:BLUEGRASS PRIMARY HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:BLUEGRASS PRIMARY HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:WRIGHTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-977-7472
Mailing Address - Street 1:1306 VERSAILLES RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1795
Mailing Address - Country:US
Mailing Address - Phone:859-259-2635
Mailing Address - Fax:859-254-7874
Practice Address - Street 1:100 VAUGHT RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2479
Practice Address - Country:US
Practice Address - Phone:859-977-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)