Provider Demographics
NPI:1346807039
Name:RUSH MEDICAL LLC
Entity Type:Organization
Organization Name:RUSH MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:D,O,M,
Authorized Official - Phone:407-505-7904
Mailing Address - Street 1:8297 CHAMPIONS GATE BLVD # 330
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8387
Mailing Address - Country:US
Mailing Address - Phone:407-505-7904
Mailing Address - Fax:407-604-6416
Practice Address - Street 1:2121 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8013
Practice Address - Country:US
Practice Address - Phone:407-505-7904
Practice Address - Fax:407-604-6416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty