MEDICARE: BLUEGRASS WOMENS CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	02725	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000202890	OTHER	KY	ANTHEM
3	2438729000	OTHER	KY	PASSPORT ADVANTAGE
4	4601014	OTHER		AETNA
5	1153124	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1144395286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS WOMENS CENTER PLLC

Provider Business Mailing Address
First Line	:	120 E ADAMS ST
Second Line	:	SUITE 6
City	:	LA GRANGE
State	:	KY
Zip	:	40031-1278
Country	:	US
Telephone Number	:	502-225-6800
Fax Number	:	502-225-6803

Provider Business Practice Location Address
First Line	:	120 E ADAMS ST
Second Line	:	SUITE 6
City	:	LA GRANGE
State	:	KY
Zip	:	40031-1278
Country	:	US
Telephone Number	:	502-225-6800
Fax Number	:	502-225-6803

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	WILLIAM EARL TRENT
Credential	:	MD
Telephone Number	:	502-225-6800

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	02/24/2009

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