Healthcare Provider Details

I. General information

NPI: 1316303860
Provider Name (Legal Business Name): RUSH-COPLEY HOSPITALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE P050
AURORA IL
60504-7222
US

IV. Provider business mailing address

2040 OGDEN AVE SUITE 313
AURORA IL
60504-7206
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-4682
  • Fax: 630-499-4750
Mailing address:
  • Phone: 630-499-2404
  • Fax: 630-499-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-116557
License Number StateIL

VIII. Authorized Official

Name: BRENDA VAN WYHE
Title or Position: CFO
Credential:
Phone: 630-499-2404