Healthcare Provider Details

I. General information

NPI: 1407985724
Provider Name (Legal Business Name): BUCKEYE FAMILY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 SHERIDAN DR SUITE 200
LANCASTER OH
43130-1378
US

IV. Provider business mailing address

1548 SHERIDAN DR SUITE 200
LANCASTER OH
43130-1378
US

V. Phone/Fax

Practice location:
  • Phone: 740-689-9860
  • Fax: 740-689-9863
Mailing address:
  • Phone: 740-689-9860
  • Fax: 740-689-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35 06 7069 P
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35 06 7069 P
License Number StateOH

VIII. Authorized Official

Name: DOUGLAS A POPE
Title or Position: OWNER
Credential: M.D.
Phone: 740-689-9860