Provider Demographics
NPI:1063402428
Name:BUSH, JAMES MICHAEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:BUSH
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 INDIANA AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6114
Mailing Address - Country:US
Mailing Address - Phone:806-698-8088
Mailing Address - Fax:806-669-8858
Practice Address - Street 1:7008 INDIANA AVE
Practice Address - Street 2:STE A
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-6114
Practice Address - Country:US
Practice Address - Phone:806-698-8088
Practice Address - Fax:806-698-8588
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163056801Medicaid
S64192Medicare UPIN
TX163056801Medicaid