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Lisa D Bush

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as LISA BUSH.

Based on the most recent information from CMS, provider Lisa D Bush is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1528372380
Provider Type
Individual
Full Name
Bush, Lisa D
Gender
Female

Sole Proprietor
No
Enumeration Date
8/3/2010
Last Updated
3/6/2022

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011

(503) 418-1472

(503) 418-1495

Mailing Location

3181 SW Sam Jackson Park Rd., Mail Code Sjh-2, Portland, OR 97239-3011

(503) 418-1472

(503) 418-1495

Provider Taxonomies

Code	Description	License
Code 363AM0700X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA152660 Oregon
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA152660 Oregon
Code 363AS0400X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Lisa D Bush

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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