Basic Information
| Provider Information | |||||||||
| NPI: | 1316303860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RUSH-COPLEY HOSPITALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 OGDEN AVE | ||||||||
| Address2: | SUITE 313 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304992404 | ||||||||
| FaxNumber: | 6304992399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 OGDEN AVE | ||||||||
| Address2: | P050 | ||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605047222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308984682 | ||||||||
| FaxNumber: | 6304994750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | VAN WYHE | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6304992404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-116557 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036-116557 | 05 | IL | MEDICAID |