1275782393 NPI number — PAMELA A BUSS RN

Table of content: PAMELA A BUSS RN (NPI 1275782393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275782393 NPI number — PAMELA A BUSS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSS
Provider First Name:
PAMELA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

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:
1275782393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
221 EAST BLUFF STREET
Provider Business Mailing Address City Name:
CASSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53806-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-725-5091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 E BLUFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASSVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-725-5091
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2008

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: 163W00000X , with the licence number:  165186-030 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: 307841-031 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35066800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6253727 . This is a "MEDICAID PA NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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