Provider Demographics
NPI:1477500668
Name:BLUEGRASS WOMENS HEALTH, PLLC
Entity Type:Organization
Organization Name:BLUEGRASS WOMENS HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-725-8373
Mailing Address - Street 1:1621 NASHVILLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-8871
Mailing Address - Country:US
Mailing Address - Phone:270-725-8373
Mailing Address - Fax:270-725-8375
Practice Address - Street 1:1621 NASHVILLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-8871
Practice Address - Country:US
Practice Address - Phone:270-725-8373
Practice Address - Fax:270-725-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI26020Medicare UPIN
KY0992101Medicare ID - Type Unspecified