Healthcare Provider Details

I. General information

NPI: 1386781789
Provider Name (Legal Business Name): BLUEGRASS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2867 CUMBERLAND FALLS HWY
CORBIN KY
40701
US

IV. Provider business mailing address

2867 CUMBERLAND FALLS HWY
CORBIN KY
40701
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-5402
  • Fax: 606-523-6517
Mailing address:
  • Phone: 606-523-5402
  • Fax: 606-523-6517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. CHAWNTAY GILMORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 606-523-5402