Provider Demographics
NPI:1720223902
Name:RUSH, SPRINGER TODD JR
Entity Type:Individual
Prefix:MR
First Name:SPRINGER
Middle Name:TODD
Last Name:RUSH
Suffix:JR
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 1:732 PLATINUM DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3420
Mailing Address - Country:US
Mailing Address - Phone:307-250-3706
Mailing Address - Fax:
Practice Address - Street 1:732 PLATINUM DR
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3420
Practice Address - Country:US
Practice Address - Phone:307-250-3706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator