Healthcare Provider Details

I. General information

NPI: 1871706127
Provider Name (Legal Business Name): RUSSELL B ALLISON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W MAIN ST
RUSSELLVILLE AR
72801-2719
US

IV. Provider business mailing address

PO BOX 1146
RUSSELLVILLE AR
72811
US

V. Phone/Fax

Practice location:
  • Phone: 479-890-9292
  • Fax: 479-890-6962
Mailing address:
  • Phone: 479-890-9292
  • Fax: 479-890-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. SABRINA PARIS HEMMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-890-9292