Provider Demographics
NPI:1144395286
Name:BLUEGRASS WOMENS CENTER PLLC
Entity Type:Organization
Organization Name:BLUEGRASS WOMENS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:TRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-225-6800
Mailing Address - Street 1:120 E ADAMS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1278
Mailing Address - Country:US
Mailing Address - Phone:502-225-6800
Mailing Address - Fax:502-225-6803
Practice Address - Street 1:120 E ADAMS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1278
Practice Address - Country:US
Practice Address - Phone:502-225-6800
Practice Address - Fax:502-225-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02725207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64040942Medicaid
KY000000202890OtherANTHEM
KY2438729000OtherPASSPORT ADVANTAGE
4601014OtherAETNA
KY1153124OtherPASSPORT
F05082Medicare UPIN