Provider Demographics
NPI:1437402443
Name:RUSH, JASON M
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:M
Last Name:RUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 CRESTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1218
Mailing Address - Country:US
Mailing Address - Phone:419-787-5707
Mailing Address - Fax:
Practice Address - Street 1:5444 CRESTHAVEN LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1218
Practice Address - Country:US
Practice Address - Phone:419-787-5707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver