Basic Information
| Provider Information | |||||||||
| NPI: | 1942342845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOODFORD HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | BLUEGRASS COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 POWELL CT | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275079 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 360 AMSDEN AVE | ||||||||
| Address2: | |||||||||
| City: | VERSAILLES | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403831851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8598733111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | GRACEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6153728500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOODFORD HOSPITAL LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 000000260987 | 01 | BLUECROSS | OTHER |