Organization
BLUEGRASS SPINE CARE, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A MYERS MD (OWNER)
(502) 633-0192
Entity
Organization
Contact information
Practice address
1741 MIDLAND TRL, SHELBYVILLE, KY 40065-1711
(502) 633-0192
(502) 633-4164
Mailing address
1741 MIDLAND TRL, SHELBYVILLE, KY 40065-1711
(502) 633-0192
(502) 633-4164
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
32619
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000802487
HUMANA
KY
01
—
1063266
PASSPORT
KY
01
—
122601
CHA
KY
01
—
2434349000
PASSPORT ADVANTAGE
KY
01
—
5134693001
CIGNA
KY
01
—
5344332
AETNA
KY
05
—
65930299
—
KY
Enumeration date
01/16/2007
Last updated
09/26/2018
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