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1437344207

NPI Code Detail

MEDICARE: RUSH AMBULATORY BEHAVIORAL HEALTH

MEDICARE: RUSH AMBULATORY BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL
2	207Q00000X	Family Medicine Physician		IL
3	207R00000X	Internal Medicine Physician		IL
4	2084P0800X	Psychiatry Physician		IL
5	2084P0804X	Child & Adolescent Psychiatry Physician		IL
6	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist		IL
7	103T00000X	Psychologist		IL

General Provider Information

NPI Number	:	1437344207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH AMBULATORY BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2150 W. HARRISON ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 W. HARRISON ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-7320
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	ARTHUR H ROGGOW
Credential	:
Telephone Number	:	312-942-7801

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	04/22/2008

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Practice Location Address:

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Directions to “RUSH AMBULATORY BEHAVIORAL HEALTH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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