Provider Demographics
NPI:1720039068
Name:RUSH COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:RUSH COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEGLEITER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-222-2545
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:801 LOCUST
Mailing Address - City:LA CROSSE
Mailing Address - State:KS
Mailing Address - Zip Code:67548-0520
Mailing Address - Country:US
Mailing Address - Phone:785-222-2545
Mailing Address - Fax:785-222-2868
Practice Address - Street 1:801 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:KS
Practice Address - Zip Code:67548-9673
Practice Address - Country:US
Practice Address - Phone:785-222-2545
Practice Address - Fax:785-222-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH083001275N00000X
KSH-083-001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1617OtherBLUE CROSS PROVIDER NUMBE
KS17Z342Medicare Oscar/Certification