Provider Demographics
NPI:1417499880
Name:BLUEGRASS EAR, NOSE & THROAT
Entity Type:Organization
Organization Name:BLUEGRASS EAR, NOSE & THROAT
Other - Org Name:ALBERT SPEACH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-277-3725
Mailing Address - Street 1:3080 HARRODSBURG RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2774
Mailing Address - Country:US
Mailing Address - Phone:859-277-3725
Mailing Address - Fax:859-276-6263
Practice Address - Street 1:3080 HARRODSBURG RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2774
Practice Address - Country:US
Practice Address - Phone:859-277-3725
Practice Address - Fax:859-276-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26776207Y00000X
KY0546231H00000X
KY1037237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1891797940OtherNPI
KY64267768Medicaid
KY1447278932OtherNPI
KY64267768Medicaid