MEDICARE: RUSH UNIVERSITY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	174400000X	Specialist
3	207RH0003X	Hematology & Oncology Physician
4	207RH0000X	Hematology (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01615605	OTHER	IL	BC PPO

General Provider Information

NPI Number	:	1003875485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH UNIVERSITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1010
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5904
Fax Number	:	312-942-3192

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 1010
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-5904
Fax Number	:	312-942-3192

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	JOHN H PAULSEN
Credential	:
Telephone Number	:	312-563-2320

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	01/21/2011

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Directions to “RUSH UNIVERSITY MEDICAL CENTER ” Practice Location

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