Provider Demographics
NPI:1295836534
Name:RUSH COPLEY MEDICAL GROUP
Entity Type:Organization
Organization Name:RUSH COPLEY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CONTRACTING & IMPLEMENTATI
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-499-4749
Mailing Address - Street 1:1256 WATERFORD DR STE 230
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4511
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-692-5518
Practice Address - Street 1:1100 VETERAN'S PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-978-6886
Practice Address - Fax:630-978-6806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH-COPLEY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL624960Medicare PIN