=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124770789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEAN BUCHANAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2022
-----------------------------------------------------
Last Update Date | 01/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17038 OTTO LN
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-345-0005
-----------------------------------------------------
Fax | 727-868-3053
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4538 COMMERCIAL WAY FL 2
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-345-0005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------