Doctor Name: | AMANDA BUSH |
NPI Number: | 1952721664 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 1001013 |
Business Practice Address: | 3500 North St Suite #1-a Nacogdoches, TX - 759652472 |
Business Phone Number: | 9365698585 |
Business Fax Number: | 9365698525 |
Mailing Address: | Po Box 1035, CENTER |
State: | TX |
Postal Code: | 759351035 |
Phone Number: | 9365904464 |
Fax Number: | 9365904468 |
NPI Enumeration Date: | 04/21/2014 |
NPI Last Update Date: | 04/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 1001013 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |