Provider Demographics
NPI:1346479581
Name:CUSHING MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:CUSHING MEMORIAL HOSPITAL CORPORATION
Other - Org Name:CUSHING MEMORIAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-684-1100
Mailing Address - Street 1:711 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3235
Mailing Address - Country:US
Mailing Address - Phone:913-684-1100
Mailing Address - Fax:
Practice Address - Street 1:711 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3235
Practice Address - Country:US
Practice Address - Phone:913-684-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUSHING MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-09
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003801Medicare PIN