Healthcare Provider Details

I. General information

NPI: 1831683879
Provider Name (Legal Business Name): BLUEGRASS BEHAVIORAL HEALTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 GOLDSMITH LN STE 117
LOUISVILLE KY
40218-3176
US

IV. Provider business mailing address

1939 GOLDSMITH LN STE 117
LOUISVILLE KY
40218-3176
US

V. Phone/Fax

Practice location:
  • Phone: 502-413-6400
  • Fax: 502-749-8720
Mailing address:
  • Phone: 502-413-6400
  • Fax: 502-749-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT W BYRD
Title or Position: PRESIDENT
Credential: MD
Phone: 502-413-6400