1659443760 NPI number — DR. JIMMIE D BUSSEY M.D.

Table of content: DR. JIMMIE D BUSSEY M.D. (NPI 1659443760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659443760 NPI number — DR. JIMMIE D BUSSEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSSEY
Provider First Name:
JIMMIE
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1659443760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 RUSK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75966-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-379-4357
Provider Business Mailing Address Fax Number:
409-379-2661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 RUSK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75966-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-379-4357
Provider Business Practice Location Address Fax Number:
409-379-2661
Provider Enumeration Date:
11/14/2006

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: 207Q00000X , with the licence number:  D4393 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 74238 . This is a "BOON CHAPMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00900 . This is a "CHRISTIAN FIDELITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41041 . This is a "FEDERATED INS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TCUCH . This is a "CBCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61271 . This is a "PRINCIPAL LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87265 . This is a "BENESIGHT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 61101 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 87043 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 84980 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 80314 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35196 . This is a "CONSECO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4405A . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62308 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80705 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91151 . This is a "STERLING" identifier . This identifiers is of the category "OTHER".




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