Provider Demographics
NPI:1164460812
Name:BLUEGRASS ORTHOPAEDICS SURGICAL DIVISION LLC
Entity Type:Organization
Organization Name:BLUEGRASS ORTHOPAEDICS SURGICAL DIVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-514-0251
Mailing Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1886
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:859-514-0253
Practice Address - Street 1:3480 YORKSHIRE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1886
Practice Address - Country:US
Practice Address - Phone:859-514-0251
Practice Address - Fax:859-514-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical