Provider Demographics
NPI:1316303860
Name:RUSH-COPLEY HOSPITALISTS, LLC
Entity type:Organization
Organization Name:RUSH-COPLEY HOSPITALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WYHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-499-2404
Mailing Address - Street 1:2040 OGDEN AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7206
Mailing Address - Country:US
Mailing Address - Phone:630-499-2404
Mailing Address - Fax:630-499-2399
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:P050
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7222
Practice Address - Country:US
Practice Address - Phone:630-898-4682
Practice Address - Fax:630-499-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-116557Medicaid