Provider Demographics
NPI:1750635926
Name:BUC CRESCENT SPRINGS LLC
Entity Type:Organization
Organization Name:BUC CRESCENT SPRINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-344-7900
Mailing Address - Street 1:2327 BUTTERMILK XING
Mailing Address - Street 2:
Mailing Address - City:CRESCENT SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1622
Mailing Address - Country:US
Mailing Address - Phone:859-344-7900
Mailing Address - Fax:859-344-0099
Practice Address - Street 1:2327 BUTTERMILK XING
Practice Address - Street 2:
Practice Address - City:CRESCENT SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:41017-1622
Practice Address - Country:US
Practice Address - Phone:859-344-7900
Practice Address - Fax:859-344-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144556Medicaid
KY7100420760Medicaid
KY7100272280Medicaid
KY7100415420Medicaid
KY7492790001Medicare NSC
KY7100415420Medicaid