Provider Demographics
NPI:1417037094
Name:BLUEGRASS I.V. CARE, INC.
Entity Type:Organization
Organization Name:BLUEGRASS I.V. CARE, INC.
Other - Org Name:BLUEGRASS HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-825-2775
Mailing Address - Street 1:1128 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1265
Mailing Address - Country:US
Mailing Address - Phone:270-825-9661
Mailing Address - Fax:270-825-3692
Practice Address - Street 1:1128 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1265
Practice Address - Country:US
Practice Address - Phone:270-825-9661
Practice Address - Fax:270-825-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMG0250332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90060542Medicaid
KY0401900001Medicare NSC