Organization
BLUEGRASS PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRUDY QUERTERMOUS (CREDENTIALING/BILLING MANAGER)
(270) 366-0960
Entity
Organization
Contact information
Practice address
242 BERGER RD, PADUCAH, KY 42003
(270) 366-0960
(270) 554-1108
Mailing address
242 BERGER RD, PADUCAH, KY 42003-4522
(270) 366-0960
(270) 554-1108
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164425831
NPI ROACH
KY
01
—
1417671041
NPI FELTS
—
01
—
1427478700
NPI GROUP
KY
05
—
64095565
—
KY
05
—
7100304720
—
KY
05
—
7100483540
—
KY
05
—
7100886900
—
KY
Enumeration date
04/24/2014
Last updated
10/15/2024
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