Provider Demographics
NPI:1407212087
Name:BUCHANAN PHYSICAL MEDICINE, INC
Entity Type:Organization
Organization Name:BUCHANAN PHYSICAL MEDICINE, INC
Other - Org Name:BUCHANAN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-787-8531
Mailing Address - Street 1:9836 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7273
Mailing Address - Country:US
Mailing Address - Phone:352-787-8531
Mailing Address - Fax:352-787-3041
Practice Address - Street 1:9836 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7273
Practice Address - Country:US
Practice Address - Phone:352-787-8531
Practice Address - Fax:352-787-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty