Provider Demographics
NPI: | 1053671255 |
---|---|
Name: | RUSH MEMORIAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | RUSH MEMORIAL HOSPITAL |
Other - Org Name: | FLATROCK RIVER LODGE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT/CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRAD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 765-932-7513 |
Mailing Address - Street 1: | 1300 N MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | RUSHVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46173-1116 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 904 E 11TH ST |
Practice Address - Street 2: | |
Practice Address - City: | RUSHVILLE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46173-1368 |
Practice Address - Country: | US |
Practice Address - Phone: | 765-932-2974 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-22 |
Last Update Date: | 2012-10-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 155630 | Medicare Oscar/Certification |