Individual ProviderTrevor BouckStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address3000 Arlington Ave., Mail Stop 1094, Toledo, OH 43614(419) 383-3761PECOS EnrollmentBased on the most recent information from CMS, provider Trevor Bouck is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records today at 11:36 AM.Profile DetailsProvider ID1265091581Provider TypeIndividualFull NameBouck, TrevorCredentialMDGenderMaleSole ProprietorNoEnumeration Date6/11/2019Last Updated6/12/2019Contact InformationPractice LocationPractice Address3000 Arlington Ave., Mail Stop 1094, Toledo, OH 43614Phone(419) 383-3761Fax(419) 383-3320Mailing LocationMailing Address3000 Arlington Ave., Mail Stop 1094, Toledo, OH 43614Phone(419) 383-3761Fax(419) 383-3526Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerOhio