Healthcare Provider Details

I. General information

NPI: 1962762047
Provider Name (Legal Business Name): RUSH UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S PAULINA ST
CHICAGO IL
60608-1221
US

IV. Provider business mailing address

1321 S PAULINA ST
CHICAGO IL
60608-1221
US

V. Phone/Fax

Practice location:
  • Phone: 773-534-7202
  • Fax: 312-666-7371
Mailing address:
  • Phone: 773-534-7202
  • Fax: 312-666-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

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