Provider Demographics
NPI:1447310396
Name:BUCHELE & ASSOCIATES SURGICAL SERVICES, LLC
Entity type:Organization
Organization Name:BUCHELE & ASSOCIATES SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUCHELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-206-3103
Mailing Address - Street 1:3103 MC CLELLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1640
Mailing Address - Country:US
Mailing Address - Phone:417-206-3103
Mailing Address - Fax:417-206-3102
Practice Address - Street 1:3103 MC CLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1640
Practice Address - Country:US
Practice Address - Phone:417-206-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500305305Medicaid
MO000014523Medicare PIN