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General NPI Number Information
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NPI Number | 1720476765
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Entity Type | Organization
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Legal Business Name | AHS CUSHING HOSPITAL LLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 1027 E CHERRY ST
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City | CUSHING
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State | OK
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Zip | 74023-4101
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Country | US
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Telephone | 918-225-8300
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Fax | 918-225-8383
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Provider Business Mailing Address
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Address Line | 1 BURTON HILLS BLVD SUITE 250
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City | NASHVILLE
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State | TN
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Zip | 37215-6293
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Country | US
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Telephone | 615-296-3000
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Fax | 615-296-6011
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Authorized Official
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Title or Position | SVP
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Name | STEPHEN C PETROVICH
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Credential |
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Telephone | 615-296-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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