Provider Demographics
NPI:1679914733
Name:BLUEGRASS FAMILY HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:BLUEGRASS FAMILY HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BASHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-971-1388
Mailing Address - Street 1:2337 ELIZABETHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-9173
Mailing Address - Country:US
Mailing Address - Phone:270-971-1388
Mailing Address - Fax:270-297-7066
Practice Address - Street 1:2337 ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-9173
Practice Address - Country:US
Practice Address - Phone:270-971-1388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007397363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty