Organization
BLUEGRASS CLINIC STANFORD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MILLER III M.D. (OWNER)
(606) 365-8338
Entity
Organization
Contact information
Practice address
107 METKER TRL, SUITE A, STANFORD, KY 40484-1049
(606) 365-8338
Mailing address
107 METKER TRL, SUITE A, STANFORD, KY 40484-1049
(606) 365-8338
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
30199
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35001882
—
KY
01
—
DE0433
RR MEDICARE GROUP NUMBER
KY
Enumeration date
02/06/2007
Last updated
10/04/2023
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