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
StateLicense IDTaxonomies
207L00000X, 207P00000X, 207Q00000X, 207R00000X, 207RC0000X, 207XS0106X, 208000000X, 2085R0202X, 208600000X, 363L00000X
IN060050822282NC0060X
IN0949341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No341600000XTransportation ServicesAmbulanceGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100269830BMedicaid
IN100269820AMedicaid
IN200861150AMedicaid
IN000000098270OtherBLUE CROSS PROVIDER #
IN100269830AMedicaid
OH0300696Medicaid
IN100269830CMedicaid
IN000000098270OtherBLUE CROSS PROVIDER #
IN151304Medicare Oscar/Certification
IN100269830CMedicaid