Provider Demographics
NPI:1366467656
Name:INJURY MANAGEMENT SPECIALISTS
Entity type:Organization
Organization Name:INJURY MANAGEMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:318-445-1196
Mailing Address - Street 1:PO BOX 13223
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315
Mailing Address - Country:US
Mailing Address - Phone:318-445-1196
Mailing Address - Fax:318-484-2662
Practice Address - Street 1:108 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:318-445-1196
Practice Address - Fax:318-484-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5K806C585Medicare ID - Type Unspecified