Provider Demographics
NPI:1922213586
Name:BLUEGRASS PLASTIC & RECONSTRUCTIVE SURGERY
Entity Type:Organization
Organization Name:BLUEGRASS PLASTIC & RECONSTRUCTIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-276-5577
Mailing Address - Street 1:1707 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1403
Mailing Address - Country:US
Mailing Address - Phone:859-276-5577
Mailing Address - Fax:859-277-4048
Practice Address - Street 1:1707 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1403
Practice Address - Country:US
Practice Address - Phone:859-276-5577
Practice Address - Fax:859-277-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty