Provider Demographics
NPI:1396783403
Name:RUSCH, JAMES A (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:RUSCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0328
Mailing Address - Country:US
Mailing Address - Phone:712-279-5830
Mailing Address - Fax:712-279-5883
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTHON
Practice Address - State:IA
Practice Address - Zip Code:51004-8199
Practice Address - Country:US
Practice Address - Phone:712-373-5711
Practice Address - Fax:712-373-5239
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000737363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R80985Medicare UPIN
IA04714Medicare PIN