Provider Demographics
NPI:1922024199
Name:CUSHING SPECIALIST GROUP
Entity Type:Organization
Organization Name:CUSHING SPECIALIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-225-6904
Mailing Address - Street 1:2340 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-2905
Mailing Address - Country:US
Mailing Address - Phone:918-225-6904
Mailing Address - Fax:918-225-4559
Practice Address - Street 1:2340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2905
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14897207VG0400X
OK2858207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty