Healthcare Provider Details

I. General information

NPI: 1164592606
Provider Name (Legal Business Name): BUCCI GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 RIVER RD
TOLEDO OH
43614-5537
US

IV. Provider business mailing address

4505 RIVER RD
TOLEDO OH
43614-5537
US

V. Phone/Fax

Practice location:
  • Phone: 419-380-9777
  • Fax:
Mailing address:
  • Phone: 419-380-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT BUCCI
Title or Position: OWNER
Credential:
Phone: 419-380-9777