Provider Demographics
NPI:1033441043
Name:EUCLID BUCKEYE MEDICAL SUPPLY CO. LLC
Entity Type:Organization
Organization Name:EUCLID BUCKEYE MEDICAL SUPPLY CO. LLC
Other - Org Name:BUCKEYE MEDICAL SUPPLY CO. LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALONDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-288-6962
Mailing Address - Street 1:26200 SHOREVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1453
Mailing Address - Country:US
Mailing Address - Phone:216-288-6962
Mailing Address - Fax:216-732-7205
Practice Address - Street 1:26200 SHOREVIEW AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1453
Practice Address - Country:US
Practice Address - Phone:216-288-6962
Practice Address - Fax:216-732-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X332B00000X
OH332BN1400X, 332BX2000X, 332S00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier