| Bluegrass Clinic Liberty, Pllc | |
|
256 N Wallace Wilkinson Blvd Liberty KY 42539-3014 | |
| (160) 678-7001 | |
| (606) 787-0035 |
| Full Name | Bluegrass Clinic Liberty, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 256 N Wallace Wilkinson Blvd, Liberty, Kentucky |
| Authorized Official Name and Position | James A Miller (PROVIDER OWNER) |
| Authorized Official Contact | 6063658338 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluegrass Clinic Liberty, Pllc 256 N Wallace Wilkinson Blvd Liberty KY 42539-3014 Ph: (606) 787-0014 | Bluegrass Clinic Liberty, Pllc 256 N Wallace Wilkinson Blvd Liberty KY 42539-3014 Ph: (160) 678-7001 |
| NPI Number | 1457555146 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 10/25/2023 |
| Medicare PECOS PAC ID | 4486747219 |
|---|---|
| Medicare Enrollment ID | O20070910000568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457555146 | NPI | - | NPPES |
| 7100032530 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Christopher D Sims |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386687457 PECOS PAC ID: 2668440322 Enrollment ID: I20040921000088 |
| Provider Name | Jeanne A Chase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487799516 PECOS PAC ID: 0446303366 Enrollment ID: I20090724000417 |
| Provider Name | John R Price |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558322966 PECOS PAC ID: 8628257854 Enrollment ID: I20110120000476 |
| Provider Name | Jody Coomer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962863407 PECOS PAC ID: 4880991488 Enrollment ID: I20160421000890 |
| Provider Name | Rhonda Lee Tokle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033609680 PECOS PAC ID: 5496002099 Enrollment ID: I20180726002797 |
| Provider Name | Lauren N Paynter |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1255956124 PECOS PAC ID: 9234553652 Enrollment ID: I20200717003061 |
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