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General NPI Number Information
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NPI Number | 1154064319
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Entity Type | Organization
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Legal Business Name | BLUEGRASS ELITE HEALTHCARE, INC.
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 3453 KY HWY 2565
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City | LOUISA
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State | KY
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Zip | 41230-5005
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Country | US
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Telephone | 606-291-7011
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Fax | 606-483-8080
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Provider Business Mailing Address
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Address Line | PO BOX 3
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City | LOUISA
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State | KY
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Zip | 41230-0003
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Country | US
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Telephone | 606-291-7011
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Fax | 866-948-3657
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Authorized Official
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Title or Position | CEO / DIRECTOR OF MISSIONS
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Name | MR. ALEX CAIN MOORE
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Credential | CEO
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Telephone | 606-471-9423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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