Healthcare Provider Details

I. General information

NPI: 1447310396
Provider Name (Legal Business Name): BUCHELE & ASSOCIATES SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 MC CLELLAND BLVD
JOPLIN MO
64804-1640
US

IV. Provider business mailing address

3103 MC CLELLAND BLVD
JOPLIN MO
64804-1640
US

V. Phone/Fax

Practice location:
  • Phone: 417-206-3103
  • Fax:
Mailing address:
  • Phone: 417-206-3103
  • Fax: 417-206-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ALAN M BUCHELE
Title or Position: MD
Credential: MD
Phone: 417-206-3103