Kentucky Mso LLC
Organization Active NPI Gastroenterology Physician · Georgetown, KY
NPI 1164867883 · NPPES record last updated Apr 21, 2023
Key facts
- NPI
- 1164867883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- Legal business name
- KENTUCKY MSO LLC
- Practice address
- 1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672 - Phone
- (502) 570-3721
- Fax
- (502) 570-3722
- NPI assigned
- May 8, 2013
- Organization subpart
- No
Authorized official
- Name
- Monica Bowman
- Title
- Corporate Secretary
- Phone
- (615) 920-7000
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 6
Practitioners 106
-
Mahmoud A. Abualayem, MD.
-
Susan Armani, APRN, PMHNP
-
Kevin Snyder Art, M.D.
-
Leslie Ann Asbury, M.D.
-
Andrew Peter Balbaugh, M.D.
-
Sarah Melissa Bond, AG-ACNP-BC
-
Parul Chaudhuri, M.D.
-
Kaylin Renae Coffman, APRN
-
Danielle Marie Dietz, M.D.
-
Laura Downes, M.D.
-
Seth T Fritz, AUD
-
Allen Thomas Griffin II, M.D.
-
Victoria Kae Gross, MSN, APRN, FNP
-
Jeneen C Haddix, APRN
-
Daniell Hill, MD
-
Imtiaz Hussain, MD
-
Candace Jones-Martin, APRN
-
Joel Anthony Knight, M.D.
-
Elizabeth Anne Markus, M.D.
-
Vinod Kumar Muniswamy, M.D., M.P.H
-
Henry Poston, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2151317 | Gastroenterology and Hepatology of the Bluegrass | Certificate of waiver | Oct 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110901000380 | KY | Part B Supplier - Clinic/Group Practice | 0749450633 |
Receives reassigned benefits from 104 practitioners 11 other NPIs on this enrollment Practice locations: Versailles, KY; Paris, KY; Mount Sterling, KY; West Liberty, KY; Winchester, KY; Georgetown, KY; Lawrencburg, KY; Lawrenceburg, KY… |
National Provider Directory
- Tax ID family
- Bluegrass Family Care Center
Locations
1350 Bull Lea Rd
Lexington, KY 40511
Phone (859) 246-7363
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | |||
| Gastroenterology Physician |
207RG0100X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672
Mailing address
1138 Lexington Rd
Suite 140
Georgetown, KY 40324-9672
Phone (502) 570-3721
Other practice location 1
138 Professional Ave
Winchester, KY 40391-1116
Phone (505) 570-3751
Other names
- Gastroenterology and Hepatology of the Bluegrass
Other providers in Georgetown, KY
- Kentucky CVS Pharmacy, L.L.C.
- Kentucky Hand & Physical Therapy, PLLC
- Kentucky Hand and Physical Therapy BC LLC
- Kentucky Medical Services Foundation
- Kentucky Mso LLC
- Kentucky Mso LLC
- Kentucky Mso LLC
- Kentucky Mso LLC
- Kentucky Mso LLC
- Kentucky Mso LLC
All providers in Georgetown, KY · Gastroenterology Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.