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Organization
BLUEGRASS URGENT CARE LLC
Active
Organization
BLUEGRASS URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SO M.D. (MEDICAL DIRECTOR)
(859) 485-7900
Entity
Organization
Contact information
Practice address
625 CHESTNUT DR, SUITE 106, WALTON, KY 41094-7845
(859) 485-7900
(859) 485-7920
Mailing address
625 CHESTNUT DR, SUITE 106, WALTON, KY 41094-7845
(859) 485-7900
(859) 485-7920
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
208D00000X
General Practice Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111587
—
OH
05
—
0144553
—
OH
05
—
2274177
—
OH
05
—
7100108440
—
KY
05
—
7100204520
—
KY
05
—
7100217560
—
KY
05
—
7100351060
—
KY
05
—
7100356480
—
KY
Enumeration date
08/25/2011
Last updated
10/04/2024
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