Healthcare Provider Details

I. General information

NPI: 1730180571
Provider Name (Legal Business Name): BLUEGRASS REGIONAL FOOT AND ANKLE ASSOCIATES P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W 5TH ST #3
LONDON KY
40741-1610
US

IV. Provider business mailing address

1105 W 5TH ST STE 3
LONDON KY
40741-2150
US

V. Phone/Fax

Practice location:
  • Phone: 606-862-9900
  • Fax: 606-862-8901
Mailing address:
  • Phone: 606-862-9900
  • Fax: 606-862-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1730180571
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL C ALBERTSON
Title or Position: PRESIDENT
Credential:
Phone: 606-862-9900