Provider Demographics
NPI:1467175513
Name:BLUEGRASS FAMILY MEDICINE HARRODSBURG PLLC
Entity Type:Organization
Organization Name:BLUEGRASS FAMILY MEDICINE HARRODSBURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-605-2324
Mailing Address - Street 1:PO BOX 910866
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0866
Mailing Address - Country:US
Mailing Address - Phone:859-605-2170
Mailing Address - Fax:859-605-2146
Practice Address - Street 1:705 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-2105
Practice Address - Country:US
Practice Address - Phone:859-605-2170
Practice Address - Fax:859-605-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty