Organization
EASTERN KENTUCKY UNIVERSITY
Active
Parent organization
EASTERN KENTUCKY UNIVERSITY
Other names
Bluegrass Community Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTERN KENTUCKY UNIVERSITY
Authorized official
SUSAN FISTER (EXECUTIVE DIRECTOR)
(859) 259-0717
Entity
Organization
Contact information
Practice address
151 N EAGLE CREEK, SUITE 220, LEXINGTON, KY 40509-1892
(859) 259-2635
(859) 254-7874
Mailing address
1306 VERSAILLES RD, SUITE 120, LEXINGTON, KY 40504-1795
(859) 259-0717
(859) 254-7874
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31001118
—
KY
Enumeration date
10/01/2007
Last updated
07/25/2011
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