Provider Demographics
NPI:1659860807
Name:BLUEGRASS MEDICAL CARE LLC
Entity type:Organization
Organization Name:BLUEGRASS MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-670-3520
Mailing Address - Street 1:4863B SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7909
Mailing Address - Country:US
Mailing Address - Phone:270-843-5662
Mailing Address - Fax:270-843-5614
Practice Address - Street 1:4863B SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7909
Practice Address - Country:US
Practice Address - Phone:270-843-5662
Practice Address - Fax:270-843-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty