Provider Demographics
NPI: | 1497726020 |
---|---|
Name: | RUSH MEMORIAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | RUSH MEMORIAL HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRADLEY |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 765-932-7513 |
Mailing Address - Street 1: | PO BOX 608 |
Mailing Address - Street 2: | |
Mailing Address - City: | RUSHVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46173-0608 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 765-932-7420 |
Mailing Address - Fax: | 765-932-7505 |
Practice Address - Street 1: | 1300 N MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | RUSHVILLE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46173-1116 |
Practice Address - Country: | US |
Practice Address - Phone: | 765-932-7420 |
Practice Address - Fax: | 765-932-7505 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | RUSH MEMORIAL HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-01-31 |
Last Update Date: | 2009-08-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207L00000X, 207P00000X, 207Q00000X, 207R00000X, 207RC0000X, 207XS0106X, 208000000X, 2085R0202X, 208600000X, 363L00000X | ||
IN | 060050822 | 282NC0060X |
IN | 0949 | 341600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282NC0060X | Hospitals | General Acute Care Hospital | Critical Access | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 341600000X | Transportation Services | Ambulance | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 100269830B | Medicaid | |
IN | 100269820A | Medicaid | |
IN | 200861150A | Medicaid | |
IN | 000000098270 | Other | BLUE CROSS PROVIDER # |
IN | 100269830A | Medicaid | |
OH | 0300696 | Medicaid | |
IN | 100269830C | Medicaid | |
IN | 000000098270 | Other | BLUE CROSS PROVIDER # |
IN | 151304 | Medicare Oscar/Certification | |
IN | 100269830C | Medicaid |