Organization
BLUERGRASS SERVICES OF KY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ROGER TOLLIVER (PRESIDENT)
(502) 428-6361
Entity
Organization
Contact information
Practice address
176 LYNNWOOD DR, MT WASHINGTON, KY 40047-7055
(502) 428-6361
Mailing address
PO BOX 304, MT WASHINGTON, KY 40047-0304
(502) 428-6361
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
T94046234
KY
Other
Enumeration date
04/25/2011
Last updated
04/25/2011
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