MEDICARE: RUSH GREEN MEDICAL ASSOCIATES

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	207R00000X	Internal Medicine Physician	2002-0296	NM

General Provider Information

NPI Number	:	1750455994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH GREEN MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 1560
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-1560
Country	:	US
Telephone Number	:	505-647-8366
Fax Number	:	505-647-8381

Provider Business Practice Location Address
First Line	:	2735 NORTHRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-0897
Country	:	US
Telephone Number	:	505-647-8366
Fax Number	:	505-647-8381

Authorized Official
Title or Position	:	MD
Name	:	MANISHA GHEI
Credential	:
Telephone Number	:	505-647-8366

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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