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General NPI Number Information
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NPI Number | 1710945076
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Entity Type | Organization
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Legal Business Name | RUSH ORTHOPEDIC AND SPORTS MEDICINE
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1800 12TH ST SUITE 1C
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City | MERIDIAN
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State | MS
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Zip | 39301-4158
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Country | US
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Telephone | 601-703-9231
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Fax | 601-703-4476
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Provider Business Mailing Address
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Address Line | P.O. DRAWER 1930
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City | MERIDIAN
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State | MS
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Zip | 39302-1930
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Country | US
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Telephone | 601-703-9506
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Fax | 601-703-3264
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUSTAVUS A. RUSH III
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Credential | M.D.
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Telephone | 601-703-9231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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