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General NPI Number Information
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NPI Number | 1003037375
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Entity Type | Organization
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Legal Business Name | BLUEGRASS CARDIOLOGY PSC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 60 MERCY COURT
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City | IRVINE
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State | KY
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Zip | 40336
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Country | US
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Telephone | 859-624-1826
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Fax | 859-624-1744
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Provider Business Mailing Address
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Address Line | 793 EASTERN BYPASS SUITE 106
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City | RICHMOND
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State | KY
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Zip | 40475
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORP PRESIDENT
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Name | DR. GLENN T MORRIS
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Credential | DO
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Telephone | 859-624-1826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 02196
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License Number State | KY
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