Provider Demographics
NPI:1952139248
Name:RUSH MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:RUSH MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-932-7078
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-7077
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:157 W FOSTER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-8778
Practice Address - Country:US
Practice Address - Phone:765-932-7690
Practice Address - Fax:765-932-7691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy