1841636289 NPI number — HEALTHFIRST BLUEGRASS, INC

Table of content: (NPI 1841636289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841636289 NPI number — HEALTHFIRST BLUEGRASS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHFIRST BLUEGRASS, INC
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:
6
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:
1841636289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
496 SOUTHLAND 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:
40503-1827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-288-2392
Provider Business Mailing Address Fax Number:
859-721-3918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 BRUCE ST
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:
40507-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-288-2425
Provider Business Practice Location Address Fax Number:
859-721-3918
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LINSCOTT
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
859-288-2425

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31000086 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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