MEDICARE: MICHAEL L RUSSELL

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912426123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L RUSSELL

Provider Business Mailing Address
First Line	:	5138 SILENT VALLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7055
Country	:	US
Telephone Number	:	702-273-8625
Fax Number	:	702-485-1210

Provider Business Practice Location Address
First Line	:	3852 PALOS VERDES ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6909
Country	:	US
Telephone Number	:	702-273-8625
Fax Number	:	702-273-8625

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

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

Similar Medicare Providers

1932511698 — FREEDOM HOUSE SOBER LIVING INC
Practice Location Address:

3852 PALOS VERDES ST , SUITE 40
LAS VEGAS, NV
89119-6909

Practice Phone: 702-485-1300
Practice Fax: 702-485-1210

1790174555 — CINDY EGAN
Practice Location Address:

3852 PALOS VERDES ST
LAS VEGAS, NV
89119-6909

Practice Phone: 702-292-8079
Practice Fax:

1962884064 — DAVID WONNACOTT
Practice Location Address:

3852 PALOS VERDES ST , SUITE 40
LAS VEGAS, NV
89119-6909

Practice Phone: 702-485-1300
Practice Fax:

1386163509 — LAUREN REAM CADC
Practice Location Address:

3852 PALOS VERDES ST
LAS VEGAS, NV
89119-6909

Practice Phone: 702-485-1210
Practice Fax:

1962921130 — KERI JEAN ANDERSON CADC, CPGC, CPGC-S
Practice Location Address:

3852 PALOS VERDES ST
LAS VEGAS, NV
89119-6909

Practice Phone: 702-485-1300
Practice Fax: 702-485-1210

1881113009 — PAUL DANIEL VAUTRINOT I
Practice Location Address:

3852 PALOS VERDES ST
LAS VEGAS, NV
89119-6909

Practice Phone: 702-485-1300
Practice Fax:

Directions to “ MICHAEL L RUSSELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.