Provider Demographics
NPI:1013671106
Name:MIDWEST ORTHOPAEDICS AT RUSH LLC
Entity Type:Organization
Organization Name:MIDWEST ORTHOPAEDICS AT RUSH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:170-823-6260
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR STE 240
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5745
Mailing Address - Country:US
Mailing Address - Phone:708-236-2600
Mailing Address - Fax:
Practice Address - Street 1:963 N 129TH INFANTRY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3104
Practice Address - Country:US
Practice Address - Phone:877-632-6637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies