Healthcare Provider Details

I. General information

NPI: 1477375608
Provider Name (Legal Business Name): BLUEGRASS INPATIENT GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

811 CORPORATE DR STE 205
LEXINGTON KY
40503-5409
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-8714
  • Fax: 859-368-7681
Mailing address:
  • Phone: 859-317-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FADI BACHA
Title or Position: OWNER
Credential: MD
Phone: 859-312-9674