Provider Demographics
NPI:1134132285
Name:BLUEGRASS OSTEOPOROSIS CENTER, PLLC
Entity Type:Organization
Organization Name:BLUEGRASS OSTEOPOROSIS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-633-0192
Mailing Address - Street 1:1741 MIDLAND TRL
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1711
Mailing Address - Country:US
Mailing Address - Phone:502-633-0192
Mailing Address - Fax:502-633-4164
Practice Address - Street 1:1741 MIDLAND TRL
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1711
Practice Address - Country:US
Practice Address - Phone:502-633-0192
Practice Address - Fax:502-633-4164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY326192471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051832OtherANTHEM
KY1131051OtherPASSPORT
KY122612OtherCHA HEALTH
KY65930679Medicaid
KY2437673000OtherPASSPORT ADVANTAGE
KY122612OtherCHA HEALTH
KYG11574Medicare UPIN
KY5279Medicare PIN