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General NPI Number Information
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NPI Number | 1871646539
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Entity Type | Organization
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Legal Business Name | BLUEGRASS GENERAL SURGERY
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 919 CHAMBERS BLVD STE D
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City | BARDSTOWN
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State | KY
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Zip | 40004-2574
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Country | US
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Telephone | 502-348-5885
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Fax | 502-348-5898
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Provider Business Mailing Address
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Address Line | 919 CHAMBERS BLVD STE D
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City | BARDSTOWN
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State | KY
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Zip | 40004-2574
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Country | US
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Telephone | 502-348-5885
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Fax | 502-348-5898
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS DAVID M FABER
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Credential | M.D.
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Telephone | 502-348-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 32091
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License Number State | KY
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