Provider Demographics
NPI:1992975841
Name:RUSH, JAMES AVERY IV (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:AVERY
Last Name:RUSH
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK DR STE 2058
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2109
Mailing Address - Country:US
Mailing Address - Phone:806-354-9540
Mailing Address - Fax:806-354-9588
Practice Address - Street 1:1901 MEDI PARK DR STE 2058
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2109
Practice Address - Country:US
Practice Address - Phone:806-354-9540
Practice Address - Fax:806-354-9588
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM75832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200332520 AMedicaid
TX206280404Medicaid
AR229922001Medicaid
NM67321232Medicaid
OK200332520 AMedicaid
TX8L14447Medicare PIN