MEDICARE: JOSHUA BUSH RN

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	163W00000X	Registered Nurse	232518	SC
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	232518	SC
3	163WX0002X	High-Risk Obstetric Registered Nurse	232518	SC
4	163WX0003X	Inpatient Obstetric Registered Nurse	232518	SC
5	163WC0400X	Case Management Registered Nurse	232518	SC

General Provider Information

NPI Number	:	1376255661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA BUSH RN

Provider Business Mailing Address
First Line	:	273 MOCKINGBIRD CIR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7709
Country	:	US
Telephone Number	:	910-616-2241
Fax Number	:	866-918-4457

Provider Business Practice Location Address
First Line	:	273 MOCKINGBIRD CIR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7709
Country	:	US
Telephone Number	:	910-616-2241
Fax Number	:	866-918-4457

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

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	01/03/2023

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