MEDICARE: BUCKEYE HOME HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	508	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336123538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE HOME HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1197
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-1197
Country	:	US
Telephone Number	:	931-879-9926
Fax Number	:	931-879-2353

Provider Business Practice Location Address
First Line	:	226 W CENTRAL AVE
Second Line	:
City	:	JAMESTOWN
State	:	TN
Zip	:	38556-3405
Country	:	US
Telephone Number	:	931-879-9926
Fax Number	:	931-879-2353

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. PAULA J ALLRED
Credential	:	DPH
Telephone Number	:	931-879-9926

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	05/10/2021

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