Healthcare Provider Details

I. General information

NPI: 1659541639
Provider Name (Legal Business Name): BLUEGRASS TECHNOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SOUTHLAND DRIVE
LEXINGTON KY
40503-1826
US

IV. Provider business mailing address

409 SOUTHLAND DRIVE
LEXINGTON KY
40503-1826
US

V. Phone/Fax

Practice location:
  • Phone: 859-294-4343
  • Fax:
Mailing address:
  • Phone: 859-294-4343
  • Fax: 859-402-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBRA SUE SHARON
Title or Position: ACTING EXECUTIVE DIRECTOR
Credential:
Phone: 859-294-4343