# BLUEGRASS MEDICAL GROUP PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164518130
- **Authorized official:** MRS. DANA RAE BARRY (PRACTICE MANAGER)
- **Authorized official phone:** (859) 277-8560

## Contact information

- **Practice address:** 1451 HARRODSBURG RD, SUITE D 502, LEXINGTON, KY 40504-3758
- **Practice address phone:** (859) 277-8560
- **Practice address fax:** (859) 277-8866
- **Mailing address:** 1451 HARRODSBURG RD, SUITE D 502, LEXINGTON, KY 40504-3758
- **Mailing address phone:** (859) 277-8560
- **Mailing address fax:** (859) 277-8866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 25337 | KY | — |
| 174400000X | Specialist | 26673 | KY | — |
| 207Q00000X | Family Medicine Physician | 41917 | KY | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 364SF0001X | Family Health Clinical Nurse Specialist | 3005655 | KY | — |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 12/18/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000055841 | ANTHEM | KY |
| 05 | — | 64253370 | — | KY |
| 05 | — | 65905234 | — | KY |