Provider Demographics
NPI:1669550695
Name:BUCKEYE ORTHOPEDIC DESIGN, INC.
Entity type:Organization
Organization Name:BUCKEYE ORTHOPEDIC DESIGN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO, LPO
Authorized Official - Phone:513-770-5550
Mailing Address - Street 1:3187 WESTERN ROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8045
Mailing Address - Country:US
Mailing Address - Phone:513-770-5550
Mailing Address - Fax:513-770-4190
Practice Address - Street 1:3187 WESTERN ROW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8045
Practice Address - Country:US
Practice Address - Phone:513-770-5550
Practice Address - Fax:513-770-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO 9222Z00000X, 335E00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2583262Medicaid
OH5427240002Medicare NSC