Provider Demographics
NPI:1124852553
Name:BUSH, CORRIE L
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:L
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 TIMBEROAKS DR
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4831
Mailing Address - Country:US
Mailing Address - Phone:817-883-6972
Mailing Address - Fax:
Practice Address - Street 1:748 TIMBEROAKS DR
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4831
Practice Address - Country:US
Practice Address - Phone:817-883-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle