Organization
RUSH PRESBYTERIAN-ST LUKES MED CTR
Active
Parent organization
RUSH UNIVERSITY MEDICAL CENTER
Other names
Rush Craniofacial Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
RUSH UNIVERSITY MEDICAL CENTER
Authorized official
JOHN W. POLLEY (MANAGER)
(312) 563-3000
Entity
Organization
Contact information
Practice address
1725 W HARRISON ST, SUITE 425, POB 1, CHICAGO, IL 60612-3841
(312) 563-3000
(312) 563-2514
Mailing address
1725 W HARRISON ST, SUITE 425, POB 1, CHICAGO, IL 60612-3841
(312) 563-3000
(312) 563-2514
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019018936
—
IL
05
—
036079739
—
IL
01
—
21623004
JWP-RCFC #
IL
01
—
32517
AAF-RCFC #
IL
Enumeration date
10/17/2006
Last updated
10/18/2010
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