Basic Information
Provider Information | |||||||||
NPI: | 1144290586 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RUSH | ||||||||
FirstName: | SHELBY | ||||||||
MiddleName: | RENAE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SCOTT | ||||||||
OtherFirstName: | SHELBY | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 203 N WASHINGTON ST STE 300 | ||||||||
Address2: |   | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 992010254 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094448888 | ||||||||
FaxNumber: | 5094447806 | ||||||||
Practice Location | |||||||||
Address1: | 401 S MAIN ST | ||||||||
Address2: |   | ||||||||
City: | DEER PARK | ||||||||
State: | WA | ||||||||
PostalCode: | 99006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5094448200 | ||||||||
FaxNumber: | 5094447806 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2006 | ||||||||
LastUpdateDate: | 07/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G80238 | CA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207QS0010X | MD60545517 | WA | N |   | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | MD60545517 | WA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.