1497726020 NPI number — RUSH MEMORIAL HOSPITAL

Table of content: (NPI 1497726020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497726020 NPI number — RUSH MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSH MEMORIAL HOSPITAL
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:
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:
1497726020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSHVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46173-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-932-7420
Provider Business Mailing Address Fax Number:
765-932-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSHVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46173-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-932-7420
Provider Business Practice Location Address Fax Number:
765-932-7505
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
765-932-7513

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0949 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 060050822 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100269830B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100269820A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200861150A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000098270 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100269830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0300696 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100269830C , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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