Provider Demographics
NPI:1457886509
Name:BUCKSKIN 903 VENTURES, LLC
Entity type:Organization
Organization Name:BUCKSKIN 903 VENTURES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-258-9061
Mailing Address - Street 1:5380 OLD BULLARD RD STE 600-264
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3607
Mailing Address - Country:US
Mailing Address - Phone:903-258-9061
Mailing Address - Fax:
Practice Address - Street 1:921 SHILOH RD STE B300
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1434
Practice Address - Country:US
Practice Address - Phone:903-258-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care