Healthcare Provider Details

I. General information

NPI: 1588625594
Provider Name (Legal Business Name): RUSH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

IV. Provider business mailing address

DEPT 3024 P O BOX 1000
MEMPHIS TN
38148-3024
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-0011
  • Fax: 601-703-3080
Mailing address:
  • Phone: 601-213-3010
  • Fax: 601-213-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DON LARKIN KENNEDY
Title or Position: REGIONAL CEO
Credential:
Phone: 601-703-9614