Provider Demographics
NPI:1972630861
Name:RUSH UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:RUSH UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FACULTY PRACTICE/OUTREACH
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DNP
Authorized Official - Phone:312-942-7013
Mailing Address - Street 1:600 S PAULINA ST
Mailing Address - Street 2:AAF SUITE 1036
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3806
Mailing Address - Country:US
Mailing Address - Phone:312-942-5836
Mailing Address - Fax:312-942-6226
Practice Address - Street 1:730 N PULASKI RD
Practice Address - Street 2:ROOM 109 ORR SCHOOL BASE HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-1063
Practice Address - Country:US
Practice Address - Phone:773-534-8924
Practice Address - Fax:773-534-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002424261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center