Provider Demographics
NPI:1316112220
Name:DOUGLAS G. CUMMINS MD PA
Entity type:Organization
Organization Name:DOUGLAS G. CUMMINS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-296-9300
Mailing Address - Street 1:2512 XENIA ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1818
Mailing Address - Country:US
Mailing Address - Phone:806-296-9300
Mailing Address - Fax:806-296-9301
Practice Address - Street 1:2512 XENIA ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1818
Practice Address - Country:US
Practice Address - Phone:806-296-9300
Practice Address - Fax:806-296-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021RHOtherBCBS
TX197822301Medicaid
TX0021RHOtherBCBS