Basic Information
| Provider Information | |||||||||
| NPI: | 1992975841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | AVERY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 MEDI PARK DR STE 2058 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791062109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063549540 | ||||||||
| FaxNumber: | 8063549588 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 MEDI PARK DR STE 2058 | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791062109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063549540 | ||||||||
| FaxNumber: | 8063549588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2008 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | M7583 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 200332520 A | 05 | OK | MEDICAID | 206280404 | 05 | TX | MEDICAID | 229922001 | 05 | AR | MEDICAID | 67321232 | 05 | NM | MEDICAID |