Provider Demographics
NPI:1083036651
Name:FOREFRONT-RUSH MEDICAL SERVICE PA
Entity Type:Organization
Organization Name:FOREFRONT-RUSH MEDICAL SERVICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:254-624-3999
Mailing Address - Street 1:3500 QUAKERBRIDGE RD # 105
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1206
Mailing Address - Country:US
Mailing Address - Phone:609-480-3109
Mailing Address - Fax:888-972-2903
Practice Address - Street 1:1901 MEDI PARK DR STE 2058
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2109
Practice Address - Country:US
Practice Address - Phone:254-624-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty