1871852582 NPI number — THE BUCKEYE RANCH, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871852582 NPI number — THE BUCKEYE RANCH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BUCKEYE RANCH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871852582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5665 HOOVER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-875-2371
Provider Business Mailing Address Fax Number:
614-875-2366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5665 HOOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43123-9122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-384-7798
Provider Business Practice Location Address Fax Number:
614-384-7798
Provider Enumeration Date:
05/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
LEIGH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
HR CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
614-396-6395

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  12433 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3153/12433 . This is a "STATE OF OHIO MACIL UPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2863718 . This is a "OHIO MITS PROVIDER ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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