Provider Demographics
NPI:1508175746
Name:RUSHING FAMILY PRACTICE
Entity Type:Organization
Organization Name:RUSHING FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-455-3500
Mailing Address - Street 1:5005 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6364
Mailing Address - Country:US
Mailing Address - Phone:903-455-3500
Mailing Address - Fax:903-455-3509
Practice Address - Street 1:5005 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6364
Practice Address - Country:US
Practice Address - Phone:903-455-3500
Practice Address - Fax:903-455-3509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSHING FAMILY PRACTICE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-06
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045098306Medicaid
TX045098306Medicaid