Healthcare Provider Details

I. General information

NPI: 1033441043
Provider Name (Legal Business Name): EUCLID BUCKEYE MEDICAL SUPPLY CO. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26200 SHOREVIEW AVE
EUCLID OH
44132-1453
US

IV. Provider business mailing address

26200 SHOREVIEW AVE
EUCLID OH
44132-1453
US

V. Phone/Fax

Practice location:
  • Phone: 216-288-6962
  • Fax: 216-732-7205
Mailing address:
  • Phone: 216-288-6962
  • Fax: 216-732-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. SHALONDA NICOLE JOHNSON
Title or Position: OWNER
Credential:
Phone: 216-288-6962