Healthcare Provider Details

I. General information

NPI: 1669592556
Provider Name (Legal Business Name): RUSHVILLE HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

IV. Provider business mailing address

2 RUBIN DR
RUSHVILLE NY
14544-9681
US

V. Phone/Fax

Practice location:
  • Phone: 585-554-4400
  • Fax: 585-554-4402
Mailing address:
  • Phone: 585-554-4400
  • Fax: 585-554-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number6121202R
License Number StateNY

VIII. Authorized Official

Name: MR. EDWARD L. NORTON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 585-554-4404