MEDICARE: BUCKEYE COMMUNITY HEALTH PLAN, 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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1700493335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE COMMUNITY HEALTH PLAN, INC.

Provider Business Mailing Address
First Line	:	7700 FORSYTH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4349 EASTON WAY STE 120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6138
Country	:	US
Telephone Number	:	855-445-3562
Fax Number	:

Authorized Official
Title or Position	:	VP, ASSOCIATE GENERAL COUNSEL
Name	:	KENNETH KOSHOREK
Credential	:
Telephone Number	:	313-720-5567

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	11/14/2025

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Directions to “BUCKEYE COMMUNITY HEALTH PLAN, INC. ” Practice Location

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