Provider Demographics
NPI:1083888010
Name:BUCKEYE FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:BUCKEYE FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-278-9666
Mailing Address - Street 1:2575 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3333
Mailing Address - Country:US
Mailing Address - Phone:614-278-9666
Mailing Address - Fax:614-278-2385
Practice Address - Street 1:1570 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2755
Practice Address - Country:US
Practice Address - Phone:614-299-9532
Practice Address - Fax:614-299-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517306Medicaid
OH2517306Medicaid