Provider Demographics
NPI:1295058493
Name:RUSHVILLE HEALTH CENTER, INC
Entity type:Organization
Organization Name:RUSHVILLE HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-703-9234
Mailing Address - Street 1:2 RUBIN DR
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9681
Mailing Address - Country:US
Mailing Address - Phone:585-554-4400
Mailing Address - Fax:585-554-4402
Practice Address - Street 1:2 RUBIN DR
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9681
Practice Address - Country:US
Practice Address - Phone:585-554-4400
Practice Address - Fax:585-554-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045814-11223G0001X
NY142366-1261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty