Provider Demographics
NPI:1447450259
Name:TOD R BUSHMAN DPM PC
Entity type:Organization
Organization Name:TOD R BUSHMAN DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-885-4424
Mailing Address - Street 1:5653 FRIST BLVD STE 441
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2062
Mailing Address - Country:US
Mailing Address - Phone:615-885-4424
Mailing Address - Fax:615-872-2707
Practice Address - Street 1:5653 FRIST BLVD STE 441
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2062
Practice Address - Country:US
Practice Address - Phone:615-885-4424
Practice Address - Fax:615-872-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM471213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376588Medicaid
TN3376588Medicaid
TN3376588Medicare PIN
TN1295810001Medicare NSC