Provider Demographics
NPI:1427061852
Name:AHS CUSHING HOSPITAL LLC
Entity type:Organization
Organization Name:AHS CUSHING HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-225-8150
Mailing Address - Street 1:1223 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4201
Mailing Address - Country:US
Mailing Address - Phone:918-225-2915
Mailing Address - Fax:918-225-2517
Practice Address - Street 1:1223 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-4201
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:2006-08-15
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7236251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200044190BMedicaid
OK377236Medicare Oscar/Certification