MEDICARE: JEFF BUSH HAS

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	237700000X	Hearing Instrument Specialist	AS5416	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AS5416	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1568928158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF BUSH HAS

Provider Business Mailing Address
First Line	:	23773 US HIGHWAY 27
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-7802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23773 US HIGHWAY 27
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-7802
Country	:	US
Telephone Number	:	863-949-4837
Fax Number	:

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

Provider Enumeration Date	:	02/19/2019
Last Update Date	:	02/19/2019

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Directions to “ JEFF BUSH HAS” Practice Location

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