Provider Demographics
NPI:1528550548
Name:GERALD BUSCH M.D.P.A.
Entity Type:Organization
Organization Name:GERALD BUSCH M.D.P.A.
Other - Org Name:PACE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-661-6904
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4647
Mailing Address - Country:US
Mailing Address - Phone:713-665-9000
Mailing Address - Fax:713-665-9100
Practice Address - Street 1:1441 HIGHWAY 6 STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4951
Practice Address - Country:US
Practice Address - Phone:866-971-8423
Practice Address - Fax:713-665-9100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERALD BUSCH M.D. P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF92602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288645903Medicaid