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BLUEGRASS PEDIATRICS LLC NPI 1427478700


NPI Information

NPI: 1427478700
Provider Name: BLUEGRASS PEDIATRICS, LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 18D2080529

Address:
242 BERGER RD
PADUCAH, KY
ZIP 42003
Phone: (270) 366-0960
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BLUEGRASS PEDIATRICS, LLC is a pediatrics in Paducah, KY. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. BLUEGRASS PEDIATRICS, LLC NPI is 1427478700. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

242 BERGER RD
PADUCAH, KY
ZIP 42003
Phone: (270) 366-0960
Fax: (270) 554-1108

The provider's authorized official is Robyn B Anderson .
The authorized official title is Billing/credentialing Manager and has the following contact phone number (270) 366-0960.

The CLIA number assigned to this NPI record is 18D2080529 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/24/2014 and was last updated on 10/8/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363L00000XNurse Practitioner3007339KENTUCKYNo
2208000000XPediatrics39216KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11912270125OTHERKENTUCKYNPI OLSON
21164425831OTHERKENTUCKYNPI ROACH
37100483540MEDICAIDKENTUCKY
47100225560OTHERKENTUCKYOLSON'S MEDICAID #
571004583540OTHERKENTUCKYAPRN GROUP MEDICAID #
664095565OTHERKENTUCKYROACH MEDICAID #
77100304720OTHERKENTUCKYGROUP MEDICAID #
81427478700OTHERKENTUCKYNPI GROUP
97100304720MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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