Organization
BLUEGRASS XRAY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL L BAKER MD (PRESIDENT)
(270) 692-5267
Entity
Organization
Contact information
Practice address
320 LORETTO RD, LEBANON, KY 40033-1300
(270) 692-5267
Mailing address
PO BOX 182255, COLUMBUS, OH 43218-2255
(513) 852-2442
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2622933000
PASSPORT ADVANTAGE
—
01
—
50007610
PASSPORT HEALTH
—
01
—
DD5463
MEDICARE RAILROAD
—
Enumeration date
06/15/2006
Last updated
08/23/2007
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