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General NPI Number Information
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NPI Number | 1639263338
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PAIN MANAGEMENT, PSC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 1760 NICHOLASVILLE ROAD SUITE 503
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-275-5229
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Fax | 859-977-2683
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Provider Business Mailing Address
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Address Line | 1760 NICHOLASVILLE ROAD SUITE 503
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City | LEXINGTON
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State | KY
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Zip | 40503
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Country | US
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Telephone | 859-275-5229
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Fax | 859-977-2683
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Authorized Official
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Title or Position | OWNER
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Name | DAVID P BOSOMWORTH II
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Credential | M.D.
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Telephone | 859-275-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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