Provider Demographics
NPI:1578557054
Name:WILLIAM STEPHEN BUSH, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:WILLIAM STEPHEN BUSH, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-366-6273
Mailing Address - Street 1:6601 WHITE FEATHER RD
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-6607
Mailing Address - Country:US
Mailing Address - Phone:760-366-6273
Mailing Address - Fax:760-366-6461
Practice Address - Street 1:6601 WHITE FEATHER RD
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-6607
Practice Address - Country:US
Practice Address - Phone:760-366-6273
Practice Address - Fax:760-366-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390650Medicaid
CA00G390650Medicare PIN
CA00G390650Medicaid