Provider Demographics
NPI:1205062478
Name:BLUEGRASS SURGICAL ASSISTANTS, PSC
Entity type:Organization
Organization Name:BLUEGRASS SURGICAL ASSISTANTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:POLLARD
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-552-7700
Mailing Address - Street 1:PO BOX 13545
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40583-3545
Mailing Address - Country:US
Mailing Address - Phone:859-552-7700
Mailing Address - Fax:
Practice Address - Street 1:4310 BETHEL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-9034
Practice Address - Country:US
Practice Address - Phone:859-552-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100076190Medicaid
KY7100069900Medicaid
KY01063001Medicare PIN
KY7100069900Medicaid