Provider Demographics
NPI:1831936343
Name:BLUEGRASS RENAL CARE, PSC
Entity type:Organization
Organization Name:BLUEGRASS RENAL CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEEB SARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-263-1717
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-0896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3229 SUMMIT SQUARE PL STE 240
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2664
Practice Address - Country:US
Practice Address - Phone:859-263-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty