Provider Demographics
NPI:1164452249
Name:RUSH SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RUSH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:541-247-3108
Mailing Address - Street 1:94220 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444
Mailing Address - Country:US
Mailing Address - Phone:541-247-3000
Mailing Address - Fax:541-247-3101
Practice Address - Street 1:648 CHETCO AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415
Practice Address - Country:US
Practice Address - Phone:541-813-1835
Practice Address - Fax:541-813-1282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CURRY HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-04
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-1579261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240088Medicaid
ORR134825Medicare PIN
OR07-1573OtherSTATE LICENSE NUMBER