| Bluegrass Legacy Healthcare, Pllc | |
|
105 Glen Oak Blvd Ste 202 Hendersonville TN 37075-3058 | |
| (615) 826-2265 | |
| (615) 826-4616 |
| Full Name | Bluegrass Legacy Healthcare, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 105 Glen Oak Blvd Ste 202, Hendersonville, Tennessee |
| Authorized Official Name and Position | Abigail Joan Eubank (NURSE PRACTITIONER) |
| Authorized Official Contact | 6158262265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluegrass Legacy Healthcare, Pllc 105 Glen Oak Blvd Ste 202 Hendersonville TN 37075-3058 Ph: (615) 826-2265 | Bluegrass Legacy Healthcare, Pllc 105 Glen Oak Blvd Ste 202 Hendersonville TN 37075-3058 Ph: (615) 826-2265 |
| NPI Number | 1467047258 |
|---|---|
| Provider Enumeration Date | 03/04/2021 |
| Last Update Date | 06/13/2024 |
| Medicare PECOS PAC ID | 7618386020 |
|---|---|
| Medicare Enrollment ID | O20210513002696 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467047258 | NPI | - | NPPES |
| 4112769 | Other | TN | BCBST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Abigail J Eubank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588861207 PECOS PAC ID: 2163448366 Enrollment ID: I20051018000078 |
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