Provider Demographics
NPI:1669754586
Name:BLUEGRASS DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:BLUEGRASS DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-438-8356
Mailing Address - Street 1:4949 BROWNSBORO RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6424
Mailing Address - Country:US
Mailing Address - Phone:502-438-8356
Mailing Address - Fax:
Practice Address - Street 1:4949 BROWNSBORO RD
Practice Address - Street 2:SUITE 215
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6424
Practice Address - Country:US
Practice Address - Phone:502-438-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies