Provider Demographics
NPI:1427206432
Name:BUCKEYE OB/GYN INC.
Entity Type:Organization
Organization Name:BUCKEYE OB/GYN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:SIERA
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-875-1721
Mailing Address - Street 1:1897 OHIO DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4839
Mailing Address - Country:US
Mailing Address - Phone:614-875-1721
Mailing Address - Fax:614-820-2337
Practice Address - Street 1:1897 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4839
Practice Address - Country:US
Practice Address - Phone:614-875-1721
Practice Address - Fax:614-820-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074253207V00000X
OH35-088486207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2731986Medicaid
OH2578581Medicaid
I68382Medicare UPIN
OHH17744Medicare UPIN