MEDICARE: BLUEGRASS TECHNOLOGY CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	252Y00000X	Early Intervention Provider Agency
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1659541639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS TECHNOLOGY CENTER

Provider Business Mailing Address
First Line	:	409 SOUTHLAND DRIVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1826
Country	:	US
Telephone Number	:	859-294-4343
Fax Number	:	859-402-0950

Provider Business Practice Location Address
First Line	:	409 SOUTHLAND DRIVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1826
Country	:	US
Telephone Number	:	859-294-4343
Fax Number	:

Authorized Official
Title or Position	:	ACTING EXECUTIVE DIRECTOR
Name	:	DEBRA SUE SHARON
Credential	:
Telephone Number	:	859-294-4343

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	08/05/2011

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