Healthcare Provider Details

I. General information

NPI: 1912079625
Provider Name (Legal Business Name): RUSH MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S ARCHUSA AVE
QUITMAN MS
39355-2331
US

IV. Provider business mailing address

DEPT 3025 PO BOX 1000
MEMPHIS TN
38148
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-6925
  • Fax: 601-776-7147
Mailing address:
  • Phone: 601-213-3010
  • Fax: 601-213-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

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