Provider Demographics
NPI:1508483512
Name:BLUEGRASS VEIN CLINIC
Entity Type:Organization
Organization Name:BLUEGRASS VEIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOENBAECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-220-8437
Mailing Address - Street 1:106 TRIGG CT
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2252
Mailing Address - Country:US
Mailing Address - Phone:270-392-3661
Mailing Address - Fax:580-297-9310
Practice Address - Street 1:201 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3486
Practice Address - Country:US
Practice Address - Phone:270-392-3661
Practice Address - Fax:580-297-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty