Provider Demographics
NPI:1679019145
Name:BLUEGRASS MEDICAL LABORATORY LLC
Entity Type:Organization
Organization Name:BLUEGRASS MEDICAL LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-580-4444
Mailing Address - Street 1:1395 E HIGHWAY 60
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-4896
Mailing Address - Country:US
Mailing Address - Phone:270-580-4444
Mailing Address - Fax:270-580-4444
Practice Address - Street 1:1395 E HIGHWAY 60
Practice Address - Street 2:SUITE A
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-4896
Practice Address - Country:US
Practice Address - Phone:270-580-4444
Practice Address - Fax:270-580-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory