Organization
BLUEGRASS EMERGENCY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED S MUSHKAT MD (MEDICAL DIRECTOR)
(270) 575-2180
Entity
Organization
Contact information
Practice address
2501 KENTUCKY AVE, PADUCAH, KY 42003-3813
(270) 575-2180
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-8642
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328885
BLUE CROSS
KY
05
—
65941163
—
KY
Enumeration date
05/09/2006
Last updated
05/09/2008
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