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General NPI Number Information
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NPI Number | 1609074624
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Entity Type | Organization
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Legal Business Name | BLUEGRASS INTERNAL MEDICINE GROUP
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 1401 HARRODSBURG RD SUITE C435
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City | LEXINGTON
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State | KY
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Zip | 40504-3751
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Country | US
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Telephone | 859-277-1570
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Fax | 859-277-1595
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Provider Business Mailing Address
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Address Line | 870 CORPORATE DR SUITE 400
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City | LEXINGTON
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State | KY
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Zip | 40503-5416
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Country | US
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Telephone | 859-277-9436
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Fax | 859-277-1765
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. MARY BETH AJELLO
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Credential |
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Telephone | 859-225-1339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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