Organization
BLUEGRASS INTERNAL MEDICINE GROUP
Active
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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