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General NPI Number Information
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NPI Number | 1972783157
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Entity Type | Organization
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Legal Business Name | BLUEGRASS FOOT AND ANKLE CARE
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 326 HIGHLAND PARK DR
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City | RICHMOND
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State | KY
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Zip | 40475-3487
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Country | US
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Telephone | 859-623-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 326 HIGHLAND PARK DR
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City | RICHMOND
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State | KY
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Zip | 40475-3487
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Country | US
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Telephone | 859-623-3550
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Fax |
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Authorized Official
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Title or Position | OWNER/DPM
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Name | DR. RANDALL W HALL
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Credential | DPM
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Telephone | 859-623-3550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00274
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 00274
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License Number State | KY
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