Provider Demographics
NPI:1578105094
Name:BLUEGRASS BONE & JOINT PLLC
Entity Type:Organization
Organization Name:BLUEGRASS BONE & JOINT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-990-8134
Mailing Address - Street 1:5353 N FEDERAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3236
Mailing Address - Country:US
Mailing Address - Phone:954-990-8134
Mailing Address - Fax:954-990-8634
Practice Address - Street 1:2137 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2242
Practice Address - Country:US
Practice Address - Phone:502-775-1511
Practice Address - Fax:502-775-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty