1558320861 NPI number — RUSH UNIVERSITY MEDICAL CENTER

Table of content: (NPI 1558320861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558320861 NPI number — RUSH UNIVERSITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSH UNIVERSITY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIVISION OF HEMATOLOGY ONCOLOGY AND SECTION OF MEDICAL ONCOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558320861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 W HARRISON ST
Provider Second Line Business Mailing Address:
SUITE 1010
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-3841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-942-5904
Provider Business Mailing Address Fax Number:
312-942-3192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 W HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 1010
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-942-5904
Provider Business Practice Location Address Fax Number:
312-942-3192
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
312-942-6909

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01616322 . This is a "BC PPO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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