Provider Demographics
NPI:1619421377
Name:RHEA BUYCKS PA LLC
Entity Type:Organization
Organization Name:RHEA BUYCKS PA LLC
Other - Org Name:ROCKFORD FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUYCKS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:580-229-3695
Mailing Address - Street 1:317 N ROCKFORD RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2552
Mailing Address - Country:US
Mailing Address - Phone:580-229-3695
Mailing Address - Fax:
Practice Address - Street 1:317 N ROCKFORD RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2552
Practice Address - Country:US
Practice Address - Phone:580-229-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty