1801987151 NPI number — ERIC J BUSH MD

Table of content: ERIC J BUSH MD (NPI 1801987151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801987151 NPI number — ERIC J BUSH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSH
Provider First Name:
ERIC
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801987151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 MAIN ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
GT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-2180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-2418
Provider Business Mailing Address Fax Number:
413-528-2907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 MAIN ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
GT BARRINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01230-2180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-528-2418
Provider Business Practice Location Address Fax Number:
413-528-2907
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  79735 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000020987 . This is a "BOSTON MEDICAL CENTER HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110228080 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3310803 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0113741 . This is a "GROUP HEALTH INCORPORATED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3149625 . This is a "MEDICAID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 079735 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11982 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10025271 . This is a "CAPITAL DISTRICT PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3149625 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68690 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BUJ16521 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 079735 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005007349 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 23827 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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