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1952187965 NPI number — NATHAN TYLER BUSH PA-C

NPI Number: 1952187965
Health Care Provider/Practitioner: NATHAN TYLER BUSH PA-C

Information about “1952187965” NPI (NATHAN TYLER BUSH PA-C) exists in 1952187965 in HTML format HTML  |  1952187965 in plain Text format TXT  |  1952187965 in PDF (Portable Document Format) PDF  |  1952187965 in an XML format XML  formats.

NPI Number : 1952187965 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952187965",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BUSH",
    "FirstName": "NATHAN",
    "MiddleName": "TYLER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "896 N 104 W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESTERTON",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46304-9626",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "219-928-6808",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "601 GATEWAY BLVD N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHESTERTON",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46304-9658",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "219-921-1444",
    "PracticeLocationAddressFaxNumber": "219-921-5303",
    "EnumerationDate": "09/05/2023",
    "LastUpdateDate": "04/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "10004155A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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