Provider Demographics
NPI:1962691923
Name:BLUEGRASS ALLERGY AND ASTHMA
Entity type:Organization
Organization Name:BLUEGRASS ALLERGY AND ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:TOLIS
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-267-0556
Mailing Address - Street 1:11900 PLANTSIDE DR
Mailing Address - Street 2:STE 9
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6367
Mailing Address - Country:US
Mailing Address - Phone:502-267-0556
Mailing Address - Fax:502-267-1715
Practice Address - Street 1:11900 PLANTSIDE DR
Practice Address - Street 2:STE 9
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6367
Practice Address - Country:US
Practice Address - Phone:502-267-0556
Practice Address - Fax:502-267-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK G. SIMON, M.D., PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-16
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34409207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYG17471Medicare UPIN
KY6341Medicare PIN