Provider Demographics
NPI:1396780078
Name:BLUEGRASS CARDIOLOGY CONSULTANTS
Entity type:Organization
Organization Name:BLUEGRASS CARDIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-875-9885
Mailing Address - Street 1:107 DIAGNOSTIC DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 DIAGNOSTIC DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6524
Practice Address - Country:US
Practice Address - Phone:502-875-9885
Practice Address - Fax:502-875-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27319207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199441Medicaid
KY64922230Medicaid
KY522398578OtherANDREW BUSTIN, MD TAX ID
KY64057623Medicaid
KY0793301Medicare ID - Type UnspecifiedANDREW BUSTIN, MD
KY64199441Medicaid
KYC68529Medicare UPIN
KYH76119Medicare UPIN
KY64922230Medicaid
KY64057623Medicaid