Provider Demographics
NPI:1760813422
Name:LANA BUCCHINO LLC
Entity Type:Organization
Organization Name:LANA BUCCHINO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-289-1011
Mailing Address - Street 1:1910 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2264
Mailing Address - Country:US
Mailing Address - Phone:765-289-1011
Mailing Address - Fax:765-289-3024
Practice Address - Street 1:1910 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2264
Practice Address - Country:US
Practice Address - Phone:765-289-1011
Practice Address - Fax:765-289-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057078A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1932120847OtherNPI