Healthcare Provider Details

I. General information

NPI: 1164133153
Provider Name (Legal Business Name): BLUEGRASS OCCUPATIONAL & ENVIRONMENTAL HEALTH CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 THIRD STREET SUITE A
CANEYVILLE KY
42721-0216
US

IV. Provider business mailing address

105 THIRD ST, SUITE A
CANEYVILLE KY
42721-0216
US

V. Phone/Fax

Practice location:
  • Phone: 270-662-1608
  • Fax:
Mailing address:
  • Phone: 270-662-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLETUS OPPONG
Title or Position: OWNER
Credential: MD
Phone: 818-406-6700