Provider Demographics
NPI:1851657803
Name:RUSH MEDICAL GROUP OF NEWTON, PA
Entity Type:Organization
Organization Name:RUSH MEDICAL GROUP OF NEWTON, PA
Other - Org Name:RUSH MEDICAL GROUP OF NEWTON-PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:LARKIN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-9614
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0309
Mailing Address - Country:US
Mailing Address - Phone:601-485-2609
Mailing Address - Fax:601-484-7565
Practice Address - Street 1:1106 CENTRAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-8972
Practice Address - Country:US
Practice Address - Phone:601-485-2609
Practice Address - Fax:601-484-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC00555Medicare UPIN