Provider Demographics
NPI:1588152649
Name:FOREFRONT-RUSH MEDICAL SERVICES PC
Entity type:Organization
Organization Name:FOREFRONT-RUSH MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:254-624-3999
Mailing Address - Street 1:1717 MAIN ST STE 5850
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7317
Mailing Address - Country:US
Mailing Address - Phone:866-959-2008
Mailing Address - Fax:888-972-2903
Practice Address - Street 1:1216 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6769
Practice Address - Country:US
Practice Address - Phone:510-201-0190
Practice Address - Fax:888-972-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7583OtherMEDICAL LICENSE