Provider Demographics
NPI:1699848770
Name:BUCKEYE MEDICAL GROUP
Entity Type:Organization
Organization Name:BUCKEYE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALGO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-432-8600
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0057
Mailing Address - Country:US
Mailing Address - Phone:740-699-1000
Mailing Address - Fax:740-699-1004
Practice Address - Street 1:918 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2949
Practice Address - Country:US
Practice Address - Phone:740-699-1000
Practice Address - Fax:740-699-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2389302Medicaid
OHDA2386OtherRR MEDICARE
OHTRICAREOtherTRICARE
OH=========00OtherOHIO BWC
OH=========00OtherOHIO BWC