| Bluegrass Direct Primary Care | |
|
227 E Main St Georgetown KY 40324-1711 | |
| (606) 424-3068 | |
| Not Available |
| Full Name | Bluegrass Direct Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 227 E Main St, Georgetown, Kentucky |
| Authorized Official Name and Position | Colton Jayne (PHYSICIAN/ OWNER) |
| Authorized Official Contact | 8597106300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluegrass Direct Primary Care 227 E Main St Georgetown KY 40324-1711 Ph: (606) 424-3068 | Bluegrass Direct Primary Care 227 E Main St Georgetown KY 40324-1711 Ph: (606) 424-3068 |
| NPI Number | 1700582327 |
|---|---|
| Provider Enumeration Date | 02/06/2023 |
| Last Update Date | 09/13/2023 |
| Certification Date | 09/13/2023 |
| Medicare PECOS PAC ID | 9335514173 |
|---|---|
| Medicare Enrollment ID | O20230410002391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700582327 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 208000000X | Pediatrics | () | Secondary |
| Provider Name | Colton T. Jayne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689108821 PECOS PAC ID: 8820347859 Enrollment ID: I20210107001897 |
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