Provider Demographics
NPI:1528041217
Name:WOMEN'S CARE OF THE BLUEGRASS
Entity Type:Organization
Organization Name:WOMEN'S CARE OF THE BLUEGRASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-227-2229
Mailing Address - Street 1:89 C. MICHAEL DAVENPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4324
Mailing Address - Country:US
Mailing Address - Phone:502-227-2229
Mailing Address - Fax:502-227-1114
Practice Address - Street 1:89 C. MICHAEL DAVENPORT BLVD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4324
Practice Address - Country:US
Practice Address - Phone:502-227-2229
Practice Address - Fax:502-227-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100029780Medicaid
KY7288Medicare PIN
KY6129Medicare PIN
KYCI6732Medicare PIN
KY7100029780Medicaid
KY6128Medicare PIN