Provider Demographics
NPI:1417984345
Name:BLUEGRASS CARDIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BLUEGRASS CARDIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:UMMAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-367-4500
Mailing Address - Street 1:1900 BLUEGRASS AVE
Mailing Address - Street 2:103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1144
Mailing Address - Country:US
Mailing Address - Phone:502-367-4500
Mailing Address - Fax:502-368-9820
Practice Address - Street 1:1900 BLUEGRASS AVE
Practice Address - Street 2:103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1144
Practice Address - Country:US
Practice Address - Phone:502-367-4500
Practice Address - Fax:502-368-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65943748Medicaid
KY9662Medicare ID - Type Unspecified