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Organization
BLUEGRASS MEDICAL CLINIC PLLC
Active
Organization
BLUEGRASS MEDICAL CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN L MOORE MD (PARTNER BLUEGRASS MEDICAL CLINIC PL)
(859) 987-0074
Entity
Organization
Contact information
Practice address
22 CLINIC DR, PARIS, KY 40361
(859) 987-0074
(859) 987-0098
Mailing address
22 CLINIC DR, PARIS, KY 40361
(859) 987-0074
(859) 987-0098
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65906455
—
KY
Enumeration date
08/18/2006
Last updated
12/18/2013
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