Basic Information
Provider Information
NPI: 1144708967
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUSH
FirstName: JOSEPH
MiddleName: A
NamePrefix: MR.
NameSuffix:  
Credential: PA-C MPAS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 109 BEE ST
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294015703
CountryCode: US
TelephoneNumber: 8435775011
FaxNumber:  
Practice Location
Address1: 109 BEE ST
Address2:  
City: CHARLESTON
State: SC
PostalCode: 29401
CountryCode: US
TelephoneNumber: 8435775011
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/02/2018
LastUpdateDate: 04/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XMA002306LPAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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