Provider Demographics
NPI:1306137336
Name:BLUEGRASS PRIMARY CARE & PEDIATRICS, PLLC
Entity type:Organization
Organization Name:BLUEGRASS PRIMARY CARE & PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MECHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-878-4302
Mailing Address - Street 1:803 MEYERS BAKER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3039
Mailing Address - Country:US
Mailing Address - Phone:606-878-4302
Mailing Address - Fax:606-878-3245
Practice Address - Street 1:803 MEYERS BAKER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3039
Practice Address - Country:US
Practice Address - Phone:606-878-4302
Practice Address - Fax:606-878-3245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty