Provider Demographics
NPI:1629234562
Name:BLUEGRASS SURGICAL ASSISTING, LLC
Entity Type:Organization
Organization Name:BLUEGRASS SURGICAL ASSISTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLL
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:502-454-7766
Mailing Address - Street 1:4119 BROWNS LN
Mailing Address - Street 2:STE 2B
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-454-7766
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:420 STILESVILLE RD
Practice Address - Street 2:
Practice Address - City:SCIENCE HILL
Practice Address - State:KY
Practice Address - Zip Code:42553-7410
Practice Address - Country:US
Practice Address - Phone:502-454-7766
Practice Address - Fax:502-451-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty