MEDICARE: RUSH MEDICAL FOUNDATION

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	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891393435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 5208
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-5208
Country	:	US
Telephone Number	:	601-703-9393
Fax Number	:	601-703-3080

Provider Business Practice Location Address
First Line	:	2800 N HILLS ST
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2643
Country	:	US
Telephone Number	:	601-484-9906
Fax Number	:	601-484-6704

Authorized Official
Title or Position	:	REGIONAL CEO
Name	:	DON LARKIN KENNEDY
Credential	:
Telephone Number	:	601-703-9614

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	04/26/2023

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Directions to “RUSH MEDICAL FOUNDATION ” Practice Location

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