# BLUEGRASS SURGICAL ASSOCIATION, PSC

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

## Provider details

- **NPI number:** 1497814768
- **Authorized official:** JOHN L KORBA MD (PRESIDENT)
- **Authorized official phone:** (270) 782-5219

## Contact information

- **Practice address:** 996 WILKINSON TRCE, SUITE A5, BOWLING GREEN, KY 42103-3407
- **Practice address phone:** (270) 782-5219
- **Practice address fax:** (270) 793-9385
- **Mailing address:** 996 WILKINSON TRCE, SUITE A5, BOWLING GREEN, KY 42103-3407
- **Mailing address phone:** (270) 782-5219
- **Mailing address fax:** (270) 793-9385

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 25747 | KY | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 12/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 65924375 | — | KY |