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General NPI Number Information
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NPI Number | 1417499880
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Entity Type | Organization
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Legal Business Name | BLUEGRASS EAR, NOSE & THROAT
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 3080 HARRODSBURG RD SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40503-2774
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Country | US
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Telephone | 859-277-3725
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Fax | 859-276-6263
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Provider Business Mailing Address
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Address Line | 3080 HARRODSBURG RD SUITE 200
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City | LEXINGTON
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State | KY
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Zip | 40503-2774
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Country | US
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Telephone | 859-277-3725
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Fax | 859-276-6263
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Authorized Official
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Title or Position | OWNER
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Name | ALBERT SPEACH
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Credential | M.D.
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Telephone | 859-277-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 1037
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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 | 26776
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 0546
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License Number State | KY
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