Provider Demographics
NPI:1164133153
Name:BLUEGRASS OCCUPATIONAL & ENVIRONMENTAL HEALTH CONSULTING LLC
Entity Type:Organization
Organization Name:BLUEGRASS OCCUPATIONAL & ENVIRONMENTAL HEALTH CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLETUS
Authorized Official - Middle Name:
Authorized Official - Last Name:OPPONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-406-6700
Mailing Address - Street 1:105 THIRD ST, SUITE A
Mailing Address - Street 2:
Mailing Address - City:CANEYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42721-0216
Mailing Address - Country:US
Mailing Address - Phone:270-662-1608
Mailing Address - Fax:
Practice Address - Street 1:105 THIRD STREET
Practice Address - Street 2:SUITE A
Practice Address - City:CANEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42721-0216
Practice Address - Country:US
Practice Address - Phone:270-662-1608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine