| Bluegrass Extended Care Services Llc | |
|
989 Governors Ln Ste 240 Lexington KY 40513-1175 | |
| (859) 338-3958 | |
| (859) 368-8135 |
| Full Name | Bluegrass Extended Care Services Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 989 Governors Ln Ste 240, Lexington, Kentucky |
| Authorized Official Name and Position | John W. Richard (OWNER) |
| Authorized Official Contact | 8593383958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluegrass Extended Care Services Llc 989 Governors Ln Ste 240 Lexington KY 40513-1175 Ph: (859) 338-3958 | Bluegrass Extended Care Services Llc 989 Governors Ln Ste 240 Lexington KY 40513-1175 Ph: (859) 338-3958 |
| NPI Number | 1912274044 |
|---|---|
| Provider Enumeration Date | 11/17/2011 |
| Last Update Date | 11/27/2023 |
| Certification Date | 11/27/2023 |
| Medicare PECOS PAC ID | 4688832090 |
|---|---|
| Medicare Enrollment ID | O20120214000748 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912274044 | NPI | - | NPPES |
| 7100185160 | Medicaid | KY | |
| 7100206250 | Medicaid | KY | |
| 7100192070 | Medicaid | KY |
| Provider Name | John W Richard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124047717 PECOS PAC ID: 2062316102 Enrollment ID: I20031121000012 |
| Provider Name | Janet M Flinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073580171 PECOS PAC ID: 2961392071 Enrollment ID: I20040319000926 |
| Provider Name | Gene Carole Nochta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477521326 PECOS PAC ID: 0244200228 Enrollment ID: I20040728000069 |
| Provider Name | Mary L Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154624492 PECOS PAC ID: 8224211008 Enrollment ID: I20110401000093 |
| Provider Name | Katherine R Waugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902266729 PECOS PAC ID: 9739479304 Enrollment ID: I20160609002454 |
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