Provider Demographics
NPI:1598322067
Name:BLUEGRASS PHARMABILLING LLC
Entity Type:Organization
Organization Name:BLUEGRASS PHARMABILLING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-761-1204
Mailing Address - Street 1:1021 KINGSWAY DR STE 11D
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3601
Mailing Address - Country:US
Mailing Address - Phone:877-761-1204
Mailing Address - Fax:
Practice Address - Street 1:1021 KINGSWAY DR STE 11D
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3601
Practice Address - Country:US
Practice Address - Phone:877-761-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies