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NPI Code Detail

MEDICARE: BLUEGRASS ORTHOTICS, LLC

MEDICARE: BLUEGRASS ORTHOTICS, LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)
3332BX2000XOxygen Equipment & Supplies (DME)
4335E00000XProsthetic/Orthotic Supplier
5332BC3200XCustomized Equipment (DME)

General Provider Information

NPI Number : 1518047596
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUEGRASS ORTHOTICS, LLC
Provider Business Mailing Address
First Line : PO BOX 97
Second Line :
City : WILLIAMSTOWN
State : KY
Zip : 41097-0097
Country : US
Telephone Number : 859-824-1000
Fax Number : 859-824-1555
Provider Business Practice Location Address
First Line : 1116 NORTH MAIN STREET
Second Line :
City : WILLIAMSTOWN
State : KY
Zip : 41097-8503
Country : US
Telephone Number : 859-824-1000
Fax Number : 859-824-1555
Authorized Official
Title or Position : OWNER
Name : MS. GEORGIA A MARSHALL
Credential :
Telephone Number : 859-824-1000
Provider Enumeration Date : 10/16/2006
Last Update Date : 10/24/2011

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Directions to “BLUEGRASS ORTHOTICS, LLC ” Practice Location

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