Basic Information
| Provider Information | |||||||||
| NPI: | 1871876342 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUSH CARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RUSH MEDICAL CLINIC-DEKALB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5166 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393025166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017434626 | ||||||||
| FaxNumber: | 6017432133 | ||||||||
| Practice Location | |||||||||
| Address1: | 14365 HIGHWAY 16 W | ||||||||
| Address2: | |||||||||
| City: | DE KALB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393287974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017434626 | ||||||||
| FaxNumber: | 6017432133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | REECE | ||||||||
| AuthorizedOfficialFirstName: | CHUCK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6017039192 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.