NPIMap

Organization Active NPI

Southern Ohio Medical Center

Doing business as SOMC Vanceburg Pharmacy

  • Community/Retail Pharmacy
  • Vanceburg, KY
National Provider Identifier
1629738679
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SOUTHERN OHIO MEDICAL CENTER
Doing business as
SOMC Vanceburg Pharmacy
Practice address
246 Commonwealth Rd
Vanceburg, KY 41179
Phone
(606) 796-0050
Fax
(606) 796-0058
NPI assigned
Dec 17, 2021
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN OHIO MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Herbert Butterbaugh, PHARMDNPI 1093230484
Title
Registered Pharmacist Supervisor
Phone
(740) 356-6853

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

246 Commonwealth Rd
Vanceburg, KY 41179

Mailing address

1805 27TH St
Portsmouth, OH 45662-2640
Phone (740) 356-6853

Other names 1

  • SOMC Vanceburg Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230906002832 KY Part B Supplier - Mass Immunization (Roster Biller Only) 8325043383 Practice locations: Vanceburg, KY
O20240802003819 KY DME Supplier - Pharmacy 8325043383 Practice locations: Vanceburg, KY

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Southern Ohio Medical Center246 Commonwealth Rd, Vanceburg, KY 41179-5003(606) 796-0050 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Sep 1, 2016

National Provider Directory

National Provider Directory
Tax ID family
South Shore Family Prac17 organizations share this tax ID, including this one
Part of
South Shore Family Prac

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1629738679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 27TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622640",
            "telephone_number": "740-356-6853",
            "fax_number": "740-356-6393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 COMMONWEALTH RD",
            "city": "VANCEBURG",
            "state": "KY",
            "postal_code": "41179",
            "telephone_number": "606-796-0050",
            "fax_number": "606-796-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN OHIO MEDICAL CENTER",
        "enumeration_date": "2021-12-17",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "BUTTERBAUGH",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "REGISTERED PHARMACIST SUPERVISOR",
        "authorized_official_telephone_number": "740-356-6853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOMC Vanceburg Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOMC Vanceburg Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vanceburg, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.