Provider Demographics
NPI:1316946429
Name:BLUEGRASS MEDICAL ASSOCIATES PSC
Entity type:Organization
Organization Name:BLUEGRASS MEDICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-223-2425
Mailing Address - Street 1:2301 RIVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1010
Mailing Address - Country:US
Mailing Address - Phone:502-814-3175
Mailing Address - Fax:502-426-5493
Practice Address - Street 1:210 MALABU DR
Practice Address - Street 2:SUITE 212
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3252
Practice Address - Country:US
Practice Address - Phone:859-223-2425
Practice Address - Fax:859-224-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933087Medicaid
KYCI922OtherRAILROAD MEDICARE KY
KYCI922OtherRAILROAD MEDICARE KY