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General NPI Number Information
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NPI Number | 1164173613
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Entity Type | Organization
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Legal Business Name | INDIANA CARE NETWORK
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 802 MCKINLEY ST
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City | BOLIVAR
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State | PA
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Zip | 15923
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Country | US
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Telephone | 724-676-4709
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Fax |
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Provider Business Mailing Address
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Address Line | 802 MCKINLEY ST
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City | BOLIVAR
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State | PA
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Zip | 15923-7971
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Country | US
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Telephone | 724-388-3814
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | BRUCE A. BUSH
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Credential | MD
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Telephone | 724-388-3814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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