Basic Information
| Provider Information | |||||||||
| NPI: | 1144275009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCUISTON | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | STEVE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 A B LASSITER RD | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420714856 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 803 POPLAR ST | ||||||||
| Address2: | |||||||||
| City: | MURRAY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420712432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707621100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 29665 | KY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64296650 | 05 | KY | MEDICAID | 000000207499 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | P00233578 | 01 | KY | RAILROAD MEDICARE | OTHER |