MEDICARE: BLUEGRASS OXYGEN INC

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	332BX2000X	Oxygen Equipment & Supplies (DME)		KY

General Provider Information

NPI Number	:	1295797587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS OXYGEN INC

Provider Business Mailing Address
First Line	:	983 PRIMROSE CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1232
Country	:	US
Telephone Number	:	859-277-2583
Fax Number	:	859-277-5454

Provider Business Practice Location Address
First Line	:	120 PROSPEROUS PL STE 210
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1866
Country	:	US
Telephone Number	:	859-277-2583
Fax Number	:	859-276-0225

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CRAIG A. COLEMAN
Credential	:	RRT
Telephone Number	:	859-277-2583

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/21/2022

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Directions to “BLUEGRASS OXYGEN INC ” Practice Location

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