Individual ProviderTheodore BushCase Manager/Care CoordinatorOther Service ProvidersPractice Address209 N Broad St Ste A, New Orleans, LA 70119(504) 577-1154PECOS EnrollmentBased on the most recent information from CMS, provider Theodore Bush does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1396116562Provider TypeIndividualFull NameBush, TheodoreTitleDr.GenderMaleSole ProprietorYesEnumeration Date10/14/2015Last Updated6/1/2018Contact InformationPractice LocationPractice Address209 N Broad St Ste A, New Orleans, LA 70119Phone(504) 577-1154FaxUnlisted FaxMailing LocationMailing Address209 N Broad St Ste A, New Orleans, LA 70119-5507Phone(504) 577-1154FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerCode101YP1600XDescriptionCounselorBehavioral Health & Social Service ProvidersLicense101YP1600XProvider IdentifiersIDDescriptionIssuerID600723292DescriptionMedicaidIssuerUnlistedLouisiana