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Organization

BLUEGRASS INTERNAL MEDICINE GROUP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARY BETH AJELLO (PRACTICE MANAGER)
(859) 225-1339
Entity
Organization

Contact information

Practice address
1401 HARRODSBURG RD, SUITE C435, LEXINGTON, KY 40504-3751
(859) 277-1570
(859) 277-1595
Mailing address
870 CORPORATE DR, SUITE 400, LEXINGTON, KY 40503-5416
(859) 277-9436
(859) 277-1765

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100002460
KY
01
DG3592
RR MEDICARE
KY
Enumeration date
07/11/2007
Last updated
05/15/2008
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