Provider Demographics
NPI:1780292110
Name:BUCKEYE SOUTH LLC
Entity type:Organization
Organization Name:BUCKEYE SOUTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-571-2399
Mailing Address - Street 1:23480 N. SUNDANCE PKWY W.
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1117
Mailing Address - Country:US
Mailing Address - Phone:623-250-4800
Mailing Address - Fax:
Practice Address - Street 1:23480 N. SUNDANCE PKWY W.
Practice Address - Street 2:SUITE 106
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3106
Practice Address - Country:US
Practice Address - Phone:623-250-4800
Practice Address - Fax:623-248-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical