Provider Demographics
NPI:1912044827
Name:BLUEGRASS MEDICAL SERVICE, LLC
Entity Type:Organization
Organization Name:BLUEGRASS MEDICAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-500-9658
Mailing Address - Street 1:6287 TAYLORSVILLE RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-6443
Mailing Address - Country:US
Mailing Address - Phone:502-253-9409
Mailing Address - Fax:502-212-5131
Practice Address - Street 1:6287 TAYLORSVILLE RD BLDG 2
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-6443
Practice Address - Country:US
Practice Address - Phone:502-253-9409
Practice Address - Fax:502-212-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY223278332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5715010001Medicare NSC