MEDICARE: RUSH UNIVERSITY MEDICAL CENTER

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	282N00000X	General Acute Care Hospital	125-053408	IL

General Provider Information

NPI Number	:	1598921991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH UNIVERSITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1116 N HERMITAGE AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7579
Country	:	US
Telephone Number	:	773-687-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W JACKSON BLVD STE 215
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3227
Country	:	US
Telephone Number	:	312-942-8000
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	DR. BLACHY JAVIER DAVILA-SALDANA
Credential	:	MD
Telephone Number	:	773-687-8654

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	08/05/2008

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