# BLUEGRASS CLINIC LIBERTY, PLLC

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

## Provider details

- **NPI number:** 1457555146
- **Authorized official:** DR. JAMES A MILLER M.D. (PROVIDER OWNER)
- **Authorized official phone:** (606) 365-8338

## Contact information

- **Practice address:** 256 N WALLACE WILKINSON BLVD, LIBERTY, KY 42539-3014
- **Practice address phone:** (160) 678-7001
- **Practice address fax:** (606) 787-0035
- **Mailing address:** 256 N WALLACE WILKINSON BLVD, LIBERTY, KY 42539-3014
- **Mailing address phone:** (606) 787-0014
- **Mailing address fax:** (606) 787-0035

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/14/2007
- **Last updated:** 10/25/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7100032530 | — | KY |