Provider Demographics
NPI:1619338373
Name:BUCKEYE FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:BUCKEYE FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-653-6105
Mailing Address - Street 1:883 LONDON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9166
Mailing Address - Country:US
Mailing Address - Phone:937-645-0102
Mailing Address - Fax:937-795-1150
Practice Address - Street 1:498 LONDON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5512
Practice Address - Country:US
Practice Address - Phone:937-578-2424
Practice Address - Fax:937-578-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2096146Medicaid
OH2096146Medicaid
OH0875142Medicare PIN