MEDICARE: BUCKEYE PREPARATORY ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1144685256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE PREPARATORY ACADEMY

Provider Business Mailing Address
First Line	:	1414 GAULT ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2933
Country	:	US
Telephone Number	:	614-252-1892
Fax Number	:	614-252-2674

Provider Business Practice Location Address
First Line	:	1414 GAULT ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2933
Country	:	US
Telephone Number	:	614-252-1892
Fax Number	:	614-252-2674

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RENEE BOLTON
Credential	:
Telephone Number	:	614-252-1892

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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Directions to “BUCKEYE PREPARATORY ACADEMY ” Practice Location

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