Provider Demographics
NPI:1942492004
Name:BUCKEYE FOOT & ANKLE LLC
Entity Type:Organization
Organization Name:BUCKEYE FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-653-6105
Mailing Address - Street 1:970 E US HIGHWAY 36
Mailing Address - Street 2:SUITE B
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1891
Mailing Address - Country:US
Mailing Address - Phone:937-653-6105
Mailing Address - Fax:937-652-4650
Practice Address - Street 1:970 E US HIGHWAY 36
Practice Address - Street 2:SUITE B
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-1891
Practice Address - Country:US
Practice Address - Phone:937-653-6105
Practice Address - Fax:937-652-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3078213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056984Medicaid
OH2056984Medicaid
OH0845531Medicare PIN
OH4157760001Medicare NSC