Provider Demographics
NPI:1669509659
Name:BUCKEYE MEDICAL SUPPLY COMPANY INC
Entity Type:Organization
Organization Name:BUCKEYE MEDICAL SUPPLY COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:BULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-381-4830
Mailing Address - Street 1:1495 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2665
Mailing Address - Country:US
Mailing Address - Phone:216-381-4830
Mailing Address - Fax:216-381-4832
Practice Address - Street 1:1495 WARRENSVILLE CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2665
Practice Address - Country:US
Practice Address - Phone:216-381-4830
Practice Address - Fax:216-381-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2039752Medicaid
OH2039752Medicaid