Healthcare Provider Details

I. General information

NPI: 1740466739
Provider Name (Legal Business Name): BLUEGRASS TRADITIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DARBY CREEK RD SUITE #12
LEXINGTON KY
40509-1604
US

IV. Provider business mailing address

501 DARBY CREEK RD SUITE #12
LEXINGTON KY
40509-1604
US

V. Phone/Fax

Practice location:
  • Phone: 859-227-1688
  • Fax:
Mailing address:
  • Phone: 859-227-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC033
License Number StateKY

VIII. Authorized Official

Name: STEVEN KEITH MORGAN
Title or Position: OWNER
Credential: C.AC
Phone: 859-227-1688