Provider Demographics
NPI:1528000106
Name:BUFFALO HEART GROUP
Entity Type:Organization
Organization Name:BUFFALO HEART GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-835-2981
Mailing Address - Street 1:3435 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1145
Mailing Address - Country:US
Mailing Address - Phone:716-835-2981
Mailing Address - Fax:
Practice Address - Street 1:3435 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1145
Practice Address - Country:US
Practice Address - Phone:716-835-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY082245Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER