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General NPI Number Information
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NPI Number | 1982755682
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Entity Type | Organization
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Legal Business Name | BLUEGRASS SPINE CARE, PSC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 1741 MIDLAND TRL
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1711
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Country | US
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Telephone | 502-633-0192
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Fax | 502-633-4164
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Provider Business Mailing Address
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Address Line | 1741 MIDLAND TRL
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1711
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Country | US
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Telephone | 502-633-0192
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Fax | 502-633-4164
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Authorized Official
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Title or Position | OWNER
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Name | MARK A MYERS
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Credential | MD
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Telephone | 502-633-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 32619
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License Number State | KY
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