Provider Demographics
NPI:1114054269
Name:BLUEGRASS OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:BLUEGRASS OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-570-9396
Mailing Address - Street 1:1140 LEXINGTON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-570-9396
Mailing Address - Fax:502-570-9336
Practice Address - Street 1:1140 LEXINGTON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-570-9396
Practice Address - Fax:502-570-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933053Medicaid
KY7473Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER