Provider Demographics
NPI:1871531277
Name:BUCKEYE DIALYSIS SUPPLY COMPANY
Entity type:Organization
Organization Name:BUCKEYE DIALYSIS SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP STRAGETIC PLANNING
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-295-7003
Mailing Address - Street 1:18720 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4855
Mailing Address - Country:US
Mailing Address - Phone:216-283-7208
Mailing Address - Fax:216-283-7230
Practice Address - Street 1:18720 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-4855
Practice Address - Country:US
Practice Address - Phone:216-283-7208
Practice Address - Fax:216-283-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0693290Medicaid
OH65944OtherQUALCHOICE
OH000000156098OtherANTHEM
OH000000156098OtherANTHEM
OH0693290Medicaid