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General NPI Number Information
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NPI Number | 1124893540
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Entity Type | Organization
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Legal Business Name | RUSH EYE PREMIUM SURGICAL SUITE LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 7625 FLEMING AVE
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City | AMARILLO
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State | TX
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Zip | 79106-1801
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Country | US
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Telephone | 806-353-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 7625 FLEMING AVE
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City | AMARILLO
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State | TX
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Zip | 79106-1801
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Country | US
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Telephone | 806-353-0125
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SLOAN RUSH
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Credential | MD
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Telephone | 806-353-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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