1003869439 NPI number — VIKAS BHUSHAN MD

Table of content: VIKAS BHUSHAN MD (NPI 1003869439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003869439 NPI number — VIKAS BHUSHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHUSHAN
Provider First Name:
VIKAS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003869439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-945-2455
Provider Business Mailing Address Fax Number:
770-237-1831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7710T CHERRY PARK DR # 522
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77095-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-572-8456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  L3921 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: E4260 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200101060A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154218506 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154218503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003869439 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161954001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23381256 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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