MEDICARE: BLUEGRASS ID ASSOCIATED LLC

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	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1588402044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS ID ASSOCIATED LLC

Provider Business Mailing Address
First Line	:	5200 BABCOCK ST NE STE 303
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4648
Country	:	US
Telephone Number	:	321-499-3077
Fax Number	:	888-440-8238

Provider Business Practice Location Address
First Line	:	5200 BABCOCK ST NE STE 303
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-4648
Country	:	US
Telephone Number	:	321-499-3077
Fax Number	:	888-440-8238

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ORIANA RAMIREZ
Credential	:	MD
Telephone Number	:	321-499-3077

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	06/17/2026

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