Healthcare Provider Details

I. General information

NPI: 1154382893
Provider Name (Legal Business Name): RUSH UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W JACKSON BLVD SUITE 310
CHICAGO IL
60612-3276
US

IV. Provider business mailing address

1645 W JACKSON BLVD SUITE 310
CHICAGO IL
60612-3276
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8060
  • Fax:
Mailing address:
  • Phone: 312-942-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIAN T SMITH
Title or Position: VICE PRESIDENT/AUTHORIZED OFFICIAL
Credential:
Phone: 312-942-6909