=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346481850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUSH MEDICAL GROUP OF NEWTON, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2009
-----------------------------------------------------
Last Update Date | 03/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2303 13TH ST
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39301-3940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-485-2609
-----------------------------------------------------
Fax | 601-484-7565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 309
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39302-0309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-485-2609
-----------------------------------------------------
Fax | 601-484-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DON LARKIN KENNEDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-703-9614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------