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General NPI Number Information
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NPI Number | 1609956903
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Entity Type | Organization
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Legal Business Name | RUSH PRESBYTERIAN-ST LUKES MED CTR
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST SUITE 425, POB 1
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-563-3000
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Fax | 312-563-2514
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Provider Business Mailing Address
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Address Line | 1725 W HARRISON ST SUITE 425, POB 1
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 312-563-3000
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Fax | 312-563-2514
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN W. POLLEY
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Credential |
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Telephone | 312-563-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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