Provider Demographics
NPI:1164592606
Name:BUCCI GROUP LTD
Entity Type:Organization
Organization Name:BUCCI GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-380-9777
Mailing Address - Street 1:4505 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5537
Mailing Address - Country:US
Mailing Address - Phone:419-380-9777
Mailing Address - Fax:
Practice Address - Street 1:4505 RIVER RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5537
Practice Address - Country:US
Practice Address - Phone:419-380-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0526096Medicaid
OH3698481Medicare PIN
OHID01751Medicare PIN