| Forrest Kenton Busch, D.o. P.c. | |
|
1950 Cook St Dyersburg TN 38024 | |
| (731) 286-4300 | |
| (731) 286-8008 |
| Full Name | Forrest Kenton Busch, D.o. P.c. |
|---|---|
| Speciality | Dermatology |
| Location | 1950 Cook St, Dyersburg, Tennessee |
| Authorized Official Name and Position | Denise Ann Horner (OFFICE MANAGER) |
| Authorized Official Contact | 7312864300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forrest Kenton Busch, D.o. P.c. 1950 Cook St Dyersburg TN 38024 Ph: (731) 286-4300 | Forrest Kenton Busch, D.o. P.c. 1950 Cook St Dyersburg TN 38024 Ph: (731) 286-4300 |
| NPI Number | 1740483692 |
|---|---|
| Provider Enumeration Date | 06/07/2007 |
| Last Update Date | 09/10/2015 |
| Medicare PECOS PAC ID | 3577551605 |
|---|---|
| Medicare Enrollment ID | O20040505001325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740483692 | NPI | - | NPPES |
| 3303355 | Medicaid | TN |
| Provider Name | Vonda L Emerson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306990262 PECOS PAC ID: 7012051584 Enrollment ID: I20100222000454 |
| Provider Name | Forrest Kenton Busch |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063425791 PECOS PAC ID: 5799773834 Enrollment ID: I20110121000494 |
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