Healthcare Provider Details

I. General information

NPI: 1598896334
Provider Name (Legal Business Name): BLUEGRASS FOOT AND ANKLE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 HIGHLAND PARK DR
RICHMOND KY
40475-3487
US

IV. Provider business mailing address

326 HIGHLAND PARK DR
RICHMOND KY
40475-3487
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-3550
  • Fax:
Mailing address:
  • Phone: 859-623-3550
  • Fax: 859-623-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00274
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00274
License Number StateKY

VIII. Authorized Official

Name: DR. RANDALL W. HALL
Title or Position: BUSINESS OWNER
Credential: D.P.M.
Phone: 859-623-3550