Basic Information
| Provider Information | |||||||||
| NPI: | 1922024199 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUSHING SPECIALIST GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740232905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740232905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUBBARD | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 9182256904 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 14897 | OK | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207X00000X | 2858 | OK | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.