Provider Demographics
NPI:1760715502
Name:BUSH&GILLES
Entity Type:Organization
Organization Name:BUSH&GILLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-458-4552
Mailing Address - Street 1:907 W. MAIN ST.
Mailing Address - Street 2:BOX 218
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822
Mailing Address - Country:US
Mailing Address - Phone:715-458-4552
Mailing Address - Fax:715-458-2182
Practice Address - Street 1:907 MAIN ST.
Practice Address - Street 2:BOX 218
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822
Practice Address - Country:US
Practice Address - Phone:715-458-4552
Practice Address - Fax:715-458-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies