Buckeye M, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BUCKEYE M, LLC

Practice address

2121 Mesa Dr
Boulder, CO 80304-3621

Phone

(303) 442-4037

Fax

(303) 442-2348

NPI assigned

Dec 27, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Koretke

Title

Director of Reimbursement

Phone

(303) 238-3838

Specialties & licenses 1

Addresses

Other names 1

• Mesa Vista of Boulder Doing business as

Tax ID family

Boulder Post Acute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Buckeye M, LLC

  • Skilled Nursing Facility
  • Boulder, CO
  • NPI 1730627183
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1376182162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 MESA DR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043621",
            "telephone_number": "303-442-4037",
            "fax_number": "303-442-2348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 MESA DR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043621",
            "telephone_number": "303-442-4037",
            "fax_number": "303-442-2348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKEYE M, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "KORETKE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "303-238-3838"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Vista of Boulder",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debora Lee Bryant, MSW, LCSW
• Imani Bryant, LPCC
• Jane C. Bryant, MA, LPC
• Anna Buchanan, LMFT
• Leah Buchholtz
• Buckeye M, LLC
• Buckeye M, LLC
• Stephanie Buckholz
• Emily E. Bucy, M.D.
• Buena Nutrition

• Skilled Nursing Facility in Boulder, CO
• Providers in Boulder, CO by specialty
• Skilled Nursing Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.