Provider Demographics
NPI:1558500918
Name:BLUEGRASS KIDNEY CONSULTANTS PSC
Entity Type:Organization
Organization Name:BLUEGRASS KIDNEY CONSULTANTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAI
Authorized Official - Middle Name:P
Authorized Official - Last Name:BHIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-583-1799
Mailing Address - Street 1:13507 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7144
Mailing Address - Country:US
Mailing Address - Phone:859-291-9100
Mailing Address - Fax:859-291-9101
Practice Address - Street 1:721 S PRESTON ST FL 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2319
Practice Address - Country:US
Practice Address - Phone:502-583-1799
Practice Address - Fax:502-583-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty