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General NPI Number Information
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NPI Number | 1366029415
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Entity Type | Organization
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Legal Business Name | BUCKEYE CLINIC
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 3121 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-1306
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Country | US
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Telephone | 614-869-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 6805 AVERY MUIRFIELD DRIVE SUITE 103
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City | DUBLIN
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State | OH
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Zip | 43016-7180
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Country | US
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Telephone | 614-534-1100
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Fax | 614-792-6240
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Authorized Official
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Title or Position | MANAGER/ OWNER
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Name | MANOJ SINHA
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Credential |
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Telephone | 614-792-6242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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