1356335079 NPI number — DR. JAMES L RUSHFORD DO

Table of content: DR. JAMES L RUSHFORD DO (NPI 1356335079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356335079 NPI number — DR. JAMES L RUSHFORD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSHFORD
Provider First Name:
JAMES
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356335079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-257-6782
Provider Business Mailing Address Fax Number:
417-257-5947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 N KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-256-1745
Provider Business Practice Location Address Fax Number:
417-256-1746
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  DO730 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 036120318 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 2014031720 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206111003 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3319268 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00388661 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1356335079 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3319269 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4146675 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00232183 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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