Healthcare Provider Details

I. General information

NPI: 1215269451
Provider Name (Legal Business Name): RUSH UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5068
  • Fax: 312-942-2714
Mailing address:
  • Phone: 312-942-5068
  • Fax: 312-942-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number209001864
License Number StateIL

VIII. Authorized Official

Name: MS. DAWN D BROWN
Title or Position: ADVANCED PRACTICE NURSE,NEONATAL
Credential: RN, MSN
Phone: 312-942-5068