Provider Demographics
NPI:1821548686
Name:KENTUCKY MEDICAL CONSULTANTS OF THE BLUEGRASS, LLC
Entity Type:Organization
Organization Name:KENTUCKY MEDICAL CONSULTANTS OF THE BLUEGRASS, LLC
Other - Org Name:BEACHSIDE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:859-469-9218
Mailing Address - Street 1:717 ALLENRIDGE PT STE 120
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40510-1021
Mailing Address - Country:US
Mailing Address - Phone:859-469-9218
Mailing Address - Fax:
Practice Address - Street 1:717 ALLENRIDGE PT STE 140
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40510-1021
Practice Address - Country:US
Practice Address - Phone:859-469-9218
Practice Address - Fax:859-523-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK005917Medicare PIN