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General NPI Number Information
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NPI Number | 1225048416
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Entity Type | Organization
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Legal Business Name | BLUEGRASS EAR NOSE & THROAT CLINIC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 205 FLOYD CLAY DR SUITE 3
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City | WINCHESTER
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State | KY
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Zip | 40391-1156
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Country | US
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Telephone | 859-745-1010
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Fax | 859-745-0080
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Provider Business Mailing Address
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Address Line | 205 FLOYD CLAY DR SUITE 3
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City | WINCHESTER
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State | KY
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Zip | 40391-1156
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Country | US
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Telephone | 859-745-1010
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Fax | 859-745-0080
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Authorized Official
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Title or Position | OWNER
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Name | ARA SAMUEL MAKDESSIAN
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Credential | MD
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Telephone | 859-745-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | KY
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