MEDICARE: BUC CRESCENT SPRINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	363A00000X	Physician Assistant
3	291U00000X	Clinical Medical Laboratory
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750635926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUC CRESCENT SPRINGS LLC

Provider Business Mailing Address
First Line	:	2327 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-344-7900
Fax Number	:	859-344-0099

Provider Business Practice Location Address
First Line	:	2327 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-344-7900
Fax Number	:	859-344-0099

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ROBERT R SO
Credential	:	MD
Telephone Number	:	859-344-7900

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	12/15/2016

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Directions to “BUC CRESCENT SPRINGS LLC ” Practice Location

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