Provider Demographics
NPI:1679971139
Name:BLEDSOE HEALTH SOLUTIONS LLC
Entity Type:Organization
Organization Name:BLEDSOE HEALTH SOLUTIONS LLC
Other - Org Name:LOUISVILLE INTEGRATIVE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-895-7761
Mailing Address - Street 1:6000 BROWNSBORO PARK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-7201
Mailing Address - Country:US
Mailing Address - Phone:502-895-7761
Mailing Address - Fax:
Practice Address - Street 1:6000 BROWNSBORO PARK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-7201
Practice Address - Country:US
Practice Address - Phone:502-895-7761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty