Basic Information
| Provider Information | |||||||||
| NPI: | 1932148244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9025 OVERLOOK BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370272708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153762770 | ||||||||
| FaxNumber: | 6153762770 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 TROTWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316475034 | ||||||||
| FaxNumber: | 9345526663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 01/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD24698 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00178417 | 01 | TN | RAILROAD MEDICARE | OTHER | 1509253 | 01 | TN | MEDICAID - MTI | OTHER | 4089768 | 01 | TN | BCBS | OTHER | 1509253 | 05 | TN | MEDICAID | 4089758 | 01 | TN | BCBS | OTHER | 3894771 | 05 | TN | MEDICAID | 4200634 | 01 | TN | BCBS TN | OTHER | 4291457 | 01 | TN | BCBS - MTI | OTHER | 3894770 | 05 | TN | MEDICAID | 64923634 | 01 | KY | KY MEDICAID | OTHER |