Provider Demographics
NPI:1639346067
Name:PRIMARY CARE OF THE BLUEGRASS
Entity Type:Organization
Organization Name:PRIMARY CARE OF THE BLUEGRASS
Other - Org Name:BRYANTSVILLE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-219-2828
Mailing Address - Street 1:PO BOX 24207
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-4207
Mailing Address - Country:US
Mailing Address - Phone:859-219-2828
Mailing Address - Fax:859-219-0524
Practice Address - Street 1:9112 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-7500
Practice Address - Country:US
Practice Address - Phone:859-219-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty