Healthcare Provider Details

I. General information

NPI: 1760715502
Provider Name (Legal Business Name): BUSH&GILLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAIN ST. BOX 218
CAMERON WI
54822
US

IV. Provider business mailing address

907 W. MAIN ST. BOX 218
CAMERON WI
54822
US

V. Phone/Fax

Practice location:
  • Phone: 715-458-4552
  • Fax: 715-458-2182
Mailing address:
  • Phone: 715-458-4552
  • Fax: 715-458-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN E GILLES
Title or Position: PRES.
Credential:
Phone: 715-458-4552