Provider Demographics
NPI:1558490797
Name:BUCKEYE SPINE & REHAB INC
Entity Type:Organization
Organization Name:BUCKEYE SPINE & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:BILLER
Authorized Official - Phone:740-681-1582
Mailing Address - Street 1:2036 SCHORRWAY DR NW
Mailing Address - Street 2:BOX 847
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8410
Mailing Address - Country:US
Mailing Address - Phone:740-681-1582
Mailing Address - Fax:740-681-1586
Practice Address - Street 1:2036 SCHORRWAY DR NW
Practice Address - Street 2:BOX 847
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8410
Practice Address - Country:US
Practice Address - Phone:740-681-1582
Practice Address - Fax:740-681-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2524987Medicaid
OH2524987Medicaid