Healthcare Provider Details

I. General information

NPI: 1508175746
Provider Name (Legal Business Name): RUSHING FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 LIVE OAK ST
GREENVILLE TX
75402-6364
US

IV. Provider business mailing address

5005 LIVE OAK ST
GREENVILLE TX
75402-6364
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-3500
  • Fax: 903-455-3509
Mailing address:
  • Phone: 903-455-3500
  • Fax: 903-455-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK6283
License Number StateTX

VIII. Authorized Official

Name: DR. GINA S RUSHING
Title or Position: PHYSICIAN
Credential: D.O
Phone: 903-455-3500