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General NPI Number Information
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NPI Number | 1912054792
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Entity Type | Organization
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Legal Business Name | BEREA URGENT CARE LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 234 BRENWOOD ST
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City | BEREA
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State | KY
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Zip | 40403-1637
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Country | US
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Telephone | 859-985-0302
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Fax | 859-985-0308
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Provider Business Mailing Address
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Address Line | 234 BRENWOOD ST
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City | BEREA
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State | KY
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Zip | 40403-1637
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Country | US
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Telephone | 859-985-0302
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Fax | 859-985-0308
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Authorized Official
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Title or Position | PARTNER
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Name | NAWAR SODA
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Credential |
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Telephone | 859-985-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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