Provider Demographics
NPI:1801867643
Name:AHS CUSHING HOSPITAL LLC
Entity Type:Organization
Organization Name:AHS CUSHING HOSPITAL LLC
Other - Org Name:CUSHING REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3594
Mailing Address - Street 1:340 SEVEN SPRINGS WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5697
Mailing Address - Country:US
Mailing Address - Phone:615-296-3594
Mailing Address - Fax:918-225-2517
Practice Address - Street 1:1027 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4101
Practice Address - Country:US
Practice Address - Phone:918-225-2915
Practice Address - Fax:918-225-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2266282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200044190AMedicaid
OK200044190AMedicaid