Organization
EASTERN KENTUCKY UNIVERSITY
Active
Other names
Bluegrass Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN G. FISTER PH.D (EXECUTIVE DIRECTOR)
(859) 259-0717
Entity
Organization
Contact information
Practice address
1306 VERSAILLES RD, SUITE 120, LEXINGTON, KY 40504-1117
(859) 259-0717
(859) 254-7874
Mailing address
1306 VERSAILLES RD, SUITE 120, LEXINGTON, KY 40504-1117
(859) 259-0717
(859) 254-7874
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
700160
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000537566
ANTHEM
KY
05
—
31001118
—
KY
01
—
9968164
AETNA
KY
Enumeration date
06/03/2006
Last updated
08/30/2013
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