Organization
PRIMARY CARE OF THE BLUEGRASS, LLC
Active
Other names
CRAB ORCHARD PRIMARY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY UNDERWOOD DO (CREDENTIALING AGENT)
(859) 303-8746
Entity
Organization
Contact information
Practice address
29 MAIN ST, CRAB ORCHARD, KY 40419-6548
(606) 355-7800
(606) 355-7803
Mailing address
1031 WELLINGTON WAY STE 240, LEXINGTON, KY 40513-1257
(859) 303-8746
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
700193
KY
261QR1300X
Rural Health Clinic/Center
900266
KY
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100043870
—
KY
Enumeration date
07/09/2008
Last updated
09/02/2021
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