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General NPI Number Information
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NPI Number | 1578831848
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PRIMARY CARE MEDICINE LLC
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 914 N DIXIE AVE STE 302
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2515
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Country | US
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Telephone | 270-769-0892
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Fax | 270-769-1857
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Provider Business Mailing Address
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Address Line | 914 N DIXIE AVE STE 302
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2515
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Country | US
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Telephone | 270-769-0892
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Fax | 270-769-1857
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. SYED R QUADRI
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Credential | M.D.
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Telephone | 270-769-0892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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