Provider Demographics
NPI:1407985724
Name:BUCKEYE FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:BUCKEYE FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-689-9860
Mailing Address - Street 1:1548 SHERIDAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1378
Mailing Address - Country:US
Mailing Address - Phone:740-689-9860
Mailing Address - Fax:740-689-9863
Practice Address - Street 1:1548 SHERIDAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1378
Practice Address - Country:US
Practice Address - Phone:740-689-9860
Practice Address - Fax:740-689-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 06 7069 P207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2243754Medicaid
OH2243754Medicaid