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General NPI Number Information
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NPI Number | 1417037094
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Entity Type | Organization
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Legal Business Name | BLUEGRASS I.V. CARE, INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 1128 N MAIN ST SUITE 2
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City | MADISONVILLE
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State | KY
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Zip | 42431-1265
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Country | US
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Telephone | 270-825-9661
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Fax | 270-825-3692
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Provider Business Mailing Address
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Address Line | 1128 N MAIN ST SUITE 2
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City | MADISONVILLE
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State | KY
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Zip | 42431-1265
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Country | US
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Telephone | 270-825-9661
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Fax | 270-825-3692
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY S RUSSELL
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Credential | RPH
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Telephone | 270-825-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MG0250
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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