MEDICARE: BILLY RAY BUSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		IN

General Provider Information

NPI Number	:	1447598032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY RAY BUSH

Provider Business Mailing Address
First Line	:	55 S STATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	903-742-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE
Second Line	:	SUITE 302
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	903-742-6120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/16/2013

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Directions to “ BILLY RAY BUSH ” Practice Location

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