Provider Demographics
NPI:1871655829
Name:BUSH, TIMOTHY ALLEN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:BUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1142
Mailing Address - Street 2:
Mailing Address - City:ASH FORK
Mailing Address - State:AZ
Mailing Address - Zip Code:86320-1142
Mailing Address - Country:US
Mailing Address - Phone:928-864-6498
Mailing Address - Fax:
Practice Address - Street 1:WESTWOOD RANCH LOT 504
Practice Address - Street 2:
Practice Address - City:ASH FORK
Practice Address - State:AZ
Practice Address - Zip Code:86320-1142
Practice Address - Country:US
Practice Address - Phone:928-864-6498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider