MEDICARE: RUSH MEDICAL GROUP OF NEWTON, PA

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	207VX0000X	Obstetrics Physician

General Provider Information

NPI Number	:	1851657803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSH MEDICAL GROUP OF NEWTON, PA

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-0309
Country	:	US
Telephone Number	:	601-485-2609
Fax Number	:	601-484-7565

Provider Business Practice Location Address
First Line	:	1106 CENTRAL DR
Second Line	:	SUITE 3
City	:	PHILADELPHIA
State	:	MS
Zip	:	39350-8972
Country	:	US
Telephone Number	:	601-485-2609
Fax Number	:	601-484-7565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DON LARKIN KENNEDY
Credential	:
Telephone Number	:	601-703-9614

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	03/01/2018

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