Provider Demographics
NPI:1104954254
Name:BLUEGRASS HEMATOLOGY ONCOLOGY
Entity type:Organization
Organization Name:BLUEGRASS HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:S
Authorized Official - Last Name:METCALFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-224-3194
Mailing Address - Street 1:701 BOB O LINK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3759
Mailing Address - Country:US
Mailing Address - Phone:859-224-3194
Mailing Address - Fax:859-223-4399
Practice Address - Street 1:701 BOB O LINK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3759
Practice Address - Country:US
Practice Address - Phone:859-224-3194
Practice Address - Fax:859-223-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCF7700OtherRRMEDICARE
KY65920597Medicaid
KY65920597Medicaid