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NPI Code Detail

MEDICARE: PALLIATIVE CARE CENTER OF THE BLUEGRASS INC.

MEDICARE: PALLIATIVE CARE CENTER OF THE BLUEGRASS 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
1103TC0700XClinical Psychologist
21041C0700XClinical Social Worker
3207Q00000XFamily Medicine Physician
4207R00000XInternal Medicine Physician
5207RG0300XGeriatric Medicine (Internal Medicine) Physician
6207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician
7208100000XPhysical Medicine & Rehabilitation Physician
82081H0002XHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
9208VP0000XPain Medicine Physician
10363LA2100XAcute Care Nurse Practitioner3002782KY
11363LA2200XAdult Health Nurse Practitioner3008486KY
12363LF0000XFamily Nurse Practitioner
13364SA2100XAcute Care Clinical Nurse Specialist
14364SP0200XPediatric Clinical Nurse Specialist
15207QH0002XHospice and Palliative Medicine (Family Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427129188
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALLIATIVE CARE CENTER OF THE BLUEGRASS INC.
Provider Business Mailing Address
First Line : 1733 HARRODSBURG RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-3617
Country : US
Telephone Number : 859-278-4869
Fax Number : 859-278-7690
Provider Business Practice Location Address
First Line : 1733 HARRODSBURG RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-3617
Country : US
Telephone Number : 859-278-4869
Fax Number : 859-278-7690
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : ELIZABETH FOWLER
Credential : MPH
Telephone Number : 859-276-5344
Provider Enumeration Date : 11/13/2006
Last Update Date : 08/15/2023

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