# BEREA URGENT CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912054792
- **Authorized official:** NAWAR SODA (PARTNER)
- **Authorized official phone:** (859) 985-0302

## Contact information

- **Practice address:** 234 BRENWOOD ST, BEREA, KY 40403-1637
- **Practice address phone:** (859) 985-0302
- **Practice address fax:** (859) 985-0308
- **Mailing address:** 234 BRENWOOD ST, BEREA, KY 40403-1637
- **Mailing address phone:** (859) 985-0302
- **Mailing address fax:** (859) 985-0308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/04/2007
- **Last updated:** 05/12/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 18D1046850 | CLIA | KY |
| 05 | — | 65944373 | — | KY |