MEDICARE: MR. RON RUSHLIGHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	3426741	OR

General Provider Information

NPI Number	:	1225720949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RON RUSHLIGHT

Provider Business Mailing Address
First Line	:	1020 82ND DR
Second Line	:
City	:	GLADSTONE
State	:	OR
Zip	:	97027-1805
Country	:	US
Telephone Number	:	503-765-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 MAIN ST
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1834
Country	:	US
Telephone Number	:	971-517-7048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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