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General NPI Number Information
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NPI Number | 1619013455
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Entity Type | Organization
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Legal Business Name | RUSH SURGICENTER AT THE PROFESSIONAL BUILDING LTD. PARTNERSHIP
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST SUITE #556
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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 | 312-563-2880
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Fax | 312-563-4538
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Provider Business Mailing Address
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Address Line | 1725 W HARRISON ST SUITE #556
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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 | 312-563-2880
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Fax | 312-563-4538
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | MARGARET AVILA
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Credential |
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Telephone | 312-563-2891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1712956
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License Number State | IL
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