1164773438 NPI number — RUSH MEDICAL FOUNDATION

Table of content: (NPI 1164773438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164773438 NPI number — RUSH MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSH MEDICAL FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OCHSNER HEALTH CENTER-QUITMAN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164773438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 3027, P O BOX 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-3027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-213-3010
Provider Business Mailing Address Fax Number:
601-213-3011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 S ARCHUSA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUITMAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39355-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-776-2123
Provider Business Practice Location Address Fax Number:
601-776-6006
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
DON
Authorized Official Middle Name:
LARKIN
Authorized Official Title or Position:
REGIONAL CEO
Authorized Official Telephone Number:
601-703-9614

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009016210 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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