Organization
BUC NEWPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT R SO M.D. (MEDICAL DIRECTOR)
(859) 431-7900
Entity
Organization
Contact information
Practice address
85 CAROTHERS RD, NEWPORT, KY 41071-2415
(859) 431-7900
(859) 431-7919
Mailing address
PO BOX 1346, UNION, KY 41091-1346
(859) 431-7900
(859) 431-7919
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics 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
—
2274177
—
OH
05
—
64076169
—
KY
05
—
71001084400
—
KY
05
—
7100204520
—
KY
05
—
7100331030
—
KY
05
—
7100351060
—
KY
05
—
7100352430
—
KY
Enumeration date
08/07/2014
Last updated
10/04/2024
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