Provider Demographics
NPI:1730180571
Name:BLUEGRASS REGIONAL FOOT AND ANKLE ASSOCIATES P S C
Entity type:Organization
Organization Name:BLUEGRASS REGIONAL FOOT AND ANKLE ASSOCIATES P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-862-9900
Mailing Address - Street 1:1105 W 5TH ST
Mailing Address - Street 2:#3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1610
Mailing Address - Country:US
Mailing Address - Phone:606-862-9900
Mailing Address - Fax:606-862-8901
Practice Address - Street 1:1105 W 5TH ST
Practice Address - Street 2:#3
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1610
Practice Address - Country:US
Practice Address - Phone:606-862-9900
Practice Address - Fax:606-862-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1730180571332B00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005737Medicaid
KY78902731Medicaid
KY80900160Medicaid
KY4586160001Medicare NSC