Provider Demographics
NPI:1407022197
Name:PAULA BUSHMAN
Entity Type:Organization
Organization Name:PAULA BUSHMAN
Other - Org Name:ALTECH DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-216-9283
Mailing Address - Street 1:4020 SW 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3735
Mailing Address - Country:US
Mailing Address - Phone:866-216-9283
Mailing Address - Fax:
Practice Address - Street 1:4020 SW 54TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3735
Practice Address - Country:US
Practice Address - Phone:866-216-9283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE2070293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1484OtherBLUE CROSS BLUE SHIELD
FLE2070Medicare PIN
FLV1484OtherBLUE CROSS BLUE SHIELD