Provider Demographics
NPI:1659150316
Name:BLUEGRASS DRYP WOUND CARE LLC
Entity Type:Organization
Organization Name:BLUEGRASS DRYP WOUND CARE LLC
Other - Org Name:BLUEGRASS WOUND CARE & HYPERBARICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-503-2505
Mailing Address - Street 1:330 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7726
Mailing Address - Country:US
Mailing Address - Phone:606-503-2505
Mailing Address - Fax:606-324-9101
Practice Address - Street 1:330 21ST ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7726
Practice Address - Country:US
Practice Address - Phone:740-637-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty