Provider Demographics
NPI:1871646323
Name:BUSCH, LANCE E (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:E
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:255 BAPTIST BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-327-3195
Mailing Address - Fax:662-243-1070
Practice Address - Street 1:255 BAPTIST BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:662-327-3195
Practice Address - Fax:662-243-1070
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS13124207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110314Medicaid
MSF25830Medicare UPIN
MS00110314Medicaid