MEDICARE: BLUEGRASS FOOT AND ANKLE CARE, 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	332B00000X	Durable Medical Equipment & Medical Supplies	00274	KY
2	213E00000X	Podiatrist	00274	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000330835	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1598896334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS FOOT AND ANKLE CARE, PLLC

Provider Business Mailing Address
First Line	:	326 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-623-3550
Fax Number	:	859-623-3393

Provider Business Practice Location Address
First Line	:	326 HIGHLAND PARK DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-3487
Country	:	US
Telephone Number	:	859-623-3550
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. RANDALL W. HALL
Credential	:	D.P.M.
Telephone Number	:	859-623-3550

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/20/2019

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