Provider Demographics
NPI:1821276106
Name:WILLIAM G. BUSH M.D., P.L.L.C
Entity Type:Organization
Organization Name:WILLIAM G. BUSH M.D., P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-664-0111
Mailing Address - Street 1:1020 RIVER OAKS DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9500
Mailing Address - Country:US
Mailing Address - Phone:601-664-0111
Mailing Address - Fax:601-932-1308
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:SUITE 410
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-664-0111
Practice Address - Fax:601-932-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121297Medicaid
MS11010OtherMS STATE MEDICAL LICENSE
MSBB0532829OtherDEA NUMBER
MSB29997Medicare UPIN