Provider Demographics
NPI:1942648233
Name:BLUEGRASS RURAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:BLUEGRASS RURAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:CRACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-312-2263
Mailing Address - Street 1:8158 N US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:LOWMANSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41232-9204
Mailing Address - Country:US
Mailing Address - Phone:606-312-2263
Mailing Address - Fax:
Practice Address - Street 1:8158 N US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:LOWMANSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41232-9204
Practice Address - Country:US
Practice Address - Phone:606-312-2263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41691261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care