Provider Demographics
NPI:1184715625
Name:RUSH-COPLEY MEDICAL GROUP NFP
Entity type:Organization
Organization Name:RUSH-COPLEY MEDICAL GROUP NFP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-978-4915
Mailing Address - Street 1:1256 WATERFORD DR STE 230
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4511
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-692-5518
Practice Address - Street 1:1100 VETERANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-236-4270
Practice Address - Fax:630-236-4271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH-COPLEY MEDICAL GROUP NFP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL624960Medicare PIN