MEDICARE: DR. JENNIFER VERMAELEN RUSS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	16341	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1230202	OTHER	MS	UNITED HEALTHCARE
3	7318135	OTHER	MS	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619925666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER VERMAELEN RUSS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 17918
Second Line	:
City	:	NATCHEZ
State	:	MS
Zip	:	39122-7918
Country	:	US
Telephone Number	:	601-442-5439
Fax Number	:	601-442-3755

Provider Business Practice Location Address
First Line	:	136 JEFFERSON DAVIS BLVD
Second Line	:
City	:	NATCHEZ
State	:	MS
Zip	:	39120-5104
Country	:	US
Telephone Number	:	601-442-5439
Fax Number	:	601-442-3755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. JENNIFER VERMAELEN RUSS M.D.” Practice Location

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