MEDICARE: BUCKEYE DIAGNOSTIC SERVICES LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1720526031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE DIAGNOSTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	1209 S 10TH ST
Second Line	:	SUITE A #573
City	:	MCALLEN
State	:	TX
Zip	:	78501-5059
Country	:	US
Telephone Number	:	956-627-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	5117 N MCCOLL RD
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-2331
Country	:	US
Telephone Number	:	956-627-3131
Fax Number	:	888-505-9987

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. JOSHUA DEAN SHAVER
Credential	:
Telephone Number	:	281-944-4704

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	06/03/2019

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