MEDICARE: ERIC WILLIAM BUSCH PAC

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	363AS0400X	Surgical Physician Assistant	PA-1567	CO
2	363AS0400X	Surgical Physician Assistant	1567	CO

General Provider Information

NPI Number	:	1346289956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WILLIAM BUSCH PAC

Provider Business Mailing Address
First Line	:	PO BOX 9049
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-9049
Country	:	US
Telephone Number	:	303-938-5700
Fax Number	:	303-998-0007

Provider Business Practice Location Address
First Line	:	4743 ARAPAHOE AVE
Second Line	:	STE 202
City	:	BOULDER
State	:	CO
Zip	:	80303-1113
Country	:	US
Telephone Number	:	303-938-5700
Fax Number	:	303-998-0007

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/29/2022

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