Basic Information
| Provider Information | |||||||||
| NPI: | 1912162959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUEGRASS RURAL HEALTH CLINIC, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | STE 12 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592634341 | ||||||||
| FaxNumber: | 8592637441 | ||||||||
| Practice Location | |||||||||
| Address1: | 2734 S HIGHWAY 421 | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409627515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066582710 | ||||||||
| FaxNumber: | 6066582712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | JADHAV | ||||||||
| AuthorizedOfficialFirstName: | KISHORE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6066582710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 255P | KY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | 33372 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.