Healthcare Provider Details

I. General information

NPI: 1932187317
Provider Name (Legal Business Name): BLUEGRASS BRACING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 W MAIN ST
LEXINGTON KY
40508
US

IV. Provider business mailing address

PO BOX 1991
LEXINGTON KY
40588
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-5500
  • Fax: 859-266-5523
Mailing address:
  • Phone: 859-264-5500
  • Fax: 859-266-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number116963
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number116963
License Number StateKY

VIII. Authorized Official

Name: MR. BARRY G CRUME
Title or Position: PRESIDENT
Credential:
Phone: 859-266-5500