MEDICARE: MRS. MELISSA L 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	171R00000X	Interpreter	802098651	TX

General Provider Information

NPI Number	:	1336520212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA L BUSH

Provider Business Mailing Address
First Line	:	162 PRIVATE ROAD 30041
Second Line	:
City	:	NEW BOSTON
State	:	TX
Zip	:	75570-5836
Country	:	US
Telephone Number	:	903-314-0301
Fax Number	:	903-314-5141

Provider Business Practice Location Address
First Line	:	162 PRIVATE ROAD 30041
Second Line	:
City	:	NEW BOSTON
State	:	TX
Zip	:	75570-5836
Country	:	US
Telephone Number	:	903-314-0301
Fax Number	:	903-314-5141

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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