Provider Demographics
NPI:1720526031
Name:BUCKEYE DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:BUCKEYE DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-944-4704
Mailing Address - Street 1:1209 S 10TH ST
Mailing Address - Street 2:SUITE A #573
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5059
Mailing Address - Country:US
Mailing Address - Phone:956-627-3131
Mailing Address - Fax:
Practice Address - Street 1:5117 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2331
Practice Address - Country:US
Practice Address - Phone:956-627-3131
Practice Address - Fax:888-505-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty