Healthcare Provider Details

I. General information

NPI: 1144395286
Provider Name (Legal Business Name): BLUEGRASS WOMENS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E ADAMS ST SUITE 6
LA GRANGE KY
40031-1278
US

IV. Provider business mailing address

120 E ADAMS ST SUITE 6
LA GRANGE KY
40031-1278
US

V. Phone/Fax

Practice location:
  • Phone: 502-225-6800
  • Fax: 502-225-6803
Mailing address:
  • Phone: 502-225-6800
  • Fax: 502-225-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02725
License Number StateKY

VIII. Authorized Official

Name: WILLIAM EARL TRENT
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 502-225-6800