Provider Demographics
NPI:1578831848
Name:BLUEGRASS PRIMARY CARE MEDICINE LLC
Entity Type:Organization
Organization Name:BLUEGRASS PRIMARY CARE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-769-0892
Mailing Address - Street 1:914 N DIXIE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2515
Mailing Address - Country:US
Mailing Address - Phone:270-769-0892
Mailing Address - Fax:270-769-1857
Practice Address - Street 1:914 N DIXIE AVE STE 302
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2515
Practice Address - Country:US
Practice Address - Phone:270-769-0892
Practice Address - Fax:270-769-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty