MEDICARE: RUSH ENT & ALLERGY, PLLC

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	207Y00000X	Otolaryngology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA8012	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1447217591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH ENT & ALLERGY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1467
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-1467
Country	:	US
Telephone Number	:	601-703-9506
Fax Number	:	601-703-3264

Provider Business Practice Location Address
First Line	:	4711 POPLAR SPRINGS DR
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39305-2622
Country	:	US
Telephone Number	:	601-485-7550
Fax Number	:	601-485-7585

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH D. SIEFKER
Credential	:	M.D.
Telephone Number	:	205-459-4778

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	08/22/2020

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