1639312473 NPI number — BLUEGRASS PEDIATRIC THERAPY SERVICES LLC

Table of content: (NPI 1639312473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639312473 NPI number — BLUEGRASS PEDIATRIC THERAPY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEGRASS PEDIATRIC THERAPY SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639312473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
856 HENDERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40515-6464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-539-2844
Provider Business Mailing Address Fax Number:
859-272-7311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
856 HENDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40515-6464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-539-2844
Provider Business Practice Location Address Fax Number:
859-272-7311
Provider Enumeration Date:
04/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FOLCZYK
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
FULKERSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-539-2844

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R2280 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FIRST STEPS . This is a "FIRST STEPS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com