| Forefront-rush Medical Services Pc | |
|
1216 Twin Lakes Dr Little Rock AR 72205-6769 | |
| (510) 201-0190 | |
| (888) 972-2903 |
| Full Name | Forefront-rush Medical Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1216 Twin Lakes Dr, Little Rock, Arkansas |
| Authorized Official Name and Position | James Avery Rush (OWNER) |
| Authorized Official Contact | 2546243999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forefront-rush Medical Services Pc 3500 Quakerbridge Rd # 105 Hamilton NJ 08619-1206 Ph: (866) 959-2008 | Forefront-rush Medical Services Pc 1216 Twin Lakes Dr Little Rock AR 72205-6769 Ph: (510) 201-0190 |
| NPI Number | 1588152649 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 10/04/2021 |
| Certification Date | 10/04/2021 |
| Medicare PECOS PAC ID | 8628324878 |
|---|---|
| Medicare Enrollment ID | O20180702002149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588152649 | NPI | - | NPPES |
| M7583 | Other | TX | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Michael West |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457735102 PECOS PAC ID: 3274842844 Enrollment ID: I20151021002287 |
| Provider Name | Dahlia D Distin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346472941 PECOS PAC ID: 8527335249 Enrollment ID: I20170601000597 |
| Provider Name | James Avery Rush |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992975841 PECOS PAC ID: 9436223609 Enrollment ID: I20180703000503 |
| Provider Name | Micah Ann Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952880791 PECOS PAC ID: 0648521377 Enrollment ID: I20180919003054 |
| Provider Name | Tana L Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114334471 PECOS PAC ID: 8921365073 Enrollment ID: I20181001000453 |
| Provider Name | Brent A. Crane |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336469287 PECOS PAC ID: 9739336058 Enrollment ID: I20181023000931 |
| Provider Name | Shamalon Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659403905 PECOS PAC ID: 5698849693 Enrollment ID: I20200108000036 |
| Provider Name | Allyson Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225685142 PECOS PAC ID: 6901239045 Enrollment ID: I20200203001281 |
| Provider Name | Carrie Schmidt Konen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982630778 PECOS PAC ID: 5496942765 Enrollment ID: I20200415001979 |
| Provider Name | Chastity Q Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588299291 PECOS PAC ID: 2961832878 Enrollment ID: I20200416002749 |
| Provider Name | Martha Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831717115 PECOS PAC ID: 5294150991 Enrollment ID: I20200728003673 |
| Provider Name | Jessica Cayce |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497917678 PECOS PAC ID: 3577888262 Enrollment ID: I20200803000623 |
| Provider Name | Mark D. Gage |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972544138 PECOS PAC ID: 3577552215 Enrollment ID: I20201222000095 |
| Provider Name | Ashley Mathias |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326588526 PECOS PAC ID: 5294012928 Enrollment ID: I20210111000875 |
| Provider Name | Que'linda Tillman-wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821661802 PECOS PAC ID: 4284031048 Enrollment ID: I20210921001679 |
| Provider Name | Pamela Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932876000 PECOS PAC ID: 6406246966 Enrollment ID: I20220505002650 |
| Provider Name | Nedra Allen-jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043978422 PECOS PAC ID: 2163802802 Enrollment ID: I20220712001061 |
| Provider Name | Blake Henchcliffe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982191409 PECOS PAC ID: 2062848617 Enrollment ID: I20220715002402 |
| Provider Name | Carol G Mathews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477267193 PECOS PAC ID: 4981061587 Enrollment ID: I20230612003175 |
| Provider Name | Jonathan Dargo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760649594 PECOS PAC ID: 4385891431 Enrollment ID: I20230717000414 |
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