Healthcare Provider Details

I. General information

NPI: 1730573452
Provider Name (Legal Business Name): BLUEGRASS FAMILY MEDICINE & PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 COMMERCE DR
LANCASTER KY
40444
US

IV. Provider business mailing address

PO BOX 910866
LEXINGTON KY
40591-0866
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-1420
  • Fax: 859-792-1240
Mailing address:
  • Phone: 859-792-1420
  • Fax: 859-792-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TARIQ ARAIN
Title or Position: CONSULTANT
Credential:
Phone: 859-792-1420