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General NPI Number Information
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NPI Number | 1851657803
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Entity Type | Organization
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Legal Business Name | RUSH MEDICAL GROUP OF NEWTON, PA
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 1106 CENTRAL DR SUITE 3
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City | PHILADELPHIA
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State | MS
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Zip | 39350-8972
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Country | US
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Telephone | 601-485-2609
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Fax | 601-484-7565
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | MERIDIAN
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State | MS
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Zip | 39302-0309
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Country | US
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Telephone | 601-485-2609
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Fax | 601-484-7565
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Authorized Official
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Title or Position | PRESIDENT
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Name | DON LARKIN KENNEDY
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Credential |
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Telephone | 601-703-9614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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