Provider Demographics
NPI:1184714131
Name:BUSCH, THOMAS JOSEPH (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:BUSCH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 E MAPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6000
Mailing Address - Country:US
Mailing Address - Phone:785-285-0645
Mailing Address - Fax:
Practice Address - Street 1:1056 S VAL VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5667
Practice Address - Country:US
Practice Address - Phone:480-889-1573
Practice Address - Fax:480-889-1574
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230562367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145010Medicare ID - Type UnspecifiedPROVIDER NUMBER