Provider Demographics
NPI:1922056845
Name:RUSHING, GINA SUE (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:SUE
Last Name:RUSHING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
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
Practice Address - Country:US
Practice Address - Phone:903-455-3500
Practice Address - Fax:903-455-3509
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J1202OtherBCBS OF TEXAS
TXP00045554OtherRAILROAD MEDICARE
TX045098306Medicaid
TX045098308Medicaid
TX045098307Medicaid
TX045098309Medicaid
TX8A7768Medicare ID - Type Unspecified
TX8L26115Medicare PIN
TXG84585Medicare UPIN
TX045098306Medicaid
TX8L26113Medicare PIN
TX045098308Medicaid