Provider Demographics
NPI:1447260880
Name:RUSH OAK PARK ER PHYSICIANS GROUP
Entity type:Organization
Organization Name:RUSH OAK PARK ER PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-942-7770
Mailing Address - Street 1:520 S MAPLE AVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1022
Mailing Address - Country:US
Mailing Address - Phone:708-660-5995
Mailing Address - Fax:708-660-2374
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:708-660-5995
Practice Address - Fax:708-660-2374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062839207PE0004X
207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635416OtherBCBS ID
ILDD5518OtherRAILROAD MEDICARE
IL214714Medicare PIN
IL211951Medicare PIN