Provider Demographics
NPI:1639440340
Name:BUCKEYE SLEEP DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:BUCKEYE SLEEP DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:419-512-2301
Mailing Address - Street 1:3545 PLYMOUTH SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9581
Mailing Address - Country:US
Mailing Address - Phone:419-512-2301
Mailing Address - Fax:
Practice Address - Street 1:3545 PLYMOUTH SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-9581
Practice Address - Country:US
Practice Address - Phone:419-512-2301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic