Provider Demographics
NPI:1285985515
Name:BLUEGRASS REGIONAL FOOT AND ANKLE ASSOCIATES P S C
Entity type:Organization
Organization Name:BLUEGRASS REGIONAL FOOT AND ANKLE ASSOCIATES P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-229-2779
Mailing Address - Street 1:1105 W 5TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1610
Mailing Address - Country:US
Mailing Address - Phone:859-229-2779
Mailing Address - Fax:606-862-8901
Practice Address - Street 1:208 BELLAIRE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8840
Practice Address - Country:US
Practice Address - Phone:859-887-8026
Practice Address - Fax:859-887-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90005737Medicaid
KY1285985515Medicare NSC
KY4586160001Medicare NSC
KY7252Medicare PIN