MEDICARE: BLUEGRASS OSTEOPOROSIS CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471B0102X	Bone Densitometry Radiologic Technologist	32619	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000051832	OTHER	KY	ANTHEM
2	1131051	OTHER	KY	PASSPORT
3	122612	OTHER	KY	CHA HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2437673000	OTHER	KY	PASSPORT ADVANTAGE

General Provider Information

NPI Number	:	1134132285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS OSTEOPOROSIS CENTER, PLLC

Provider Business Mailing Address
First Line	:	1741 MIDLAND TRL
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-1711
Country	:	US
Telephone Number	:	502-633-0192
Fax Number	:	502-633-4164

Provider Business Practice Location Address
First Line	:	1741 MIDLAND TRL
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-1711
Country	:	US
Telephone Number	:	502-633-0192
Fax Number	:	502-633-4164

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK A MYERS
Credential	:	M.D.
Telephone Number	:	502-633-0192

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	05/07/2010

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