Provider Demographics
NPI:1306858402
Name:BLUEGRASS OXYGEN INC
Entity Type:Organization
Organization Name:BLUEGRASS OXYGEN INC
Other - Org Name:BLUEGRASS HOME OXYGEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:859-277-2583
Mailing Address - Street 1:983 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1232
Mailing Address - Country:US
Mailing Address - Phone:859-277-2583
Mailing Address - Fax:859-277-5454
Practice Address - Street 1:112 HARDIN LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3813
Practice Address - Country:US
Practice Address - Phone:606-679-2454
Practice Address - Fax:606-679-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1045550005Medicare NSC