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General NPI Number Information
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NPI Number | 1427349596
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Entity Type | Organization
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Legal Business Name | BLUERGRASS SERVICES OF KY LLC
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 176 LYNNWOOD DR
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City | MT WASHINGTON
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State | KY
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Zip | 40047-7055
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Country | US
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Telephone | 502-428-6361
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 304
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City | MT WASHINGTON
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State | KY
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Zip | 40047-0304
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Country | US
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Telephone | 502-428-6361
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES ROGER TOLLIVER
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Credential |
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Telephone | 502-428-6361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | T94046234
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License Number State | KY
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