Provider Demographics
NPI:1801902457
Name:BUCKEYE 96 LP
Entity type:Organization
Organization Name:BUCKEYE 96 LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PT CSCS
Authorized Official - Phone:281-325-0188
Mailing Address - Street 1:20403 UNIVERSITY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4977
Mailing Address - Country:US
Mailing Address - Phone:281-325-0188
Mailing Address - Fax:281-325-0189
Practice Address - Street 1:20403 UNIVERSITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4977
Practice Address - Country:US
Practice Address - Phone:281-325-0188
Practice Address - Fax:281-325-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0330Medicare ID - Type Unspecified