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General NPI Number Information
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NPI Number | 1508483512
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Entity Type | Organization
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Legal Business Name | BLUEGRASS VEIN CLINIC
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 201 PROFESSIONAL PARK DR
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City | GLASGOW
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State | KY
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Zip | 42141-3486
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Country | US
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Telephone | 270-392-3661
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Fax | 580-297-9310
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Provider Business Mailing Address
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Address Line | 106 TRIGG CT
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City | GLASGOW
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State | KY
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Zip | 42141-2252
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Country | US
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Telephone | 270-392-3661
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Fax | 580-297-9310
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JULIE SCHOENBAECHLER
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Credential |
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Telephone | 502-220-8437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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