Provider Demographics
NPI:1003195983
Name:BLUEGRASS PAIN CONSULTANTS PLLC
Entity Type:Organization
Organization Name:BLUEGRASS PAIN CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-423-1021
Mailing Address - Street 1:6400 DUTCHMANS PKWY STE 60
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3341
Mailing Address - Country:US
Mailing Address - Phone:502-423-1021
Mailing Address - Fax:502-423-1416
Practice Address - Street 1:6400 DUTCHMANS PKWY STE 60
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3341
Practice Address - Country:US
Practice Address - Phone:502-423-1021
Practice Address - Fax:502-423-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty