Healthcare Provider Details

I. General information

NPI: 1750383519
Provider Name (Legal Business Name): DRS RUSSELL BERKEBILE AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 BENEDICT AVE
NORWALK OH
44857-2374
US

IV. Provider business mailing address

PO BOX 678950
DALLAS TX
75267-8950
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-3131
  • Fax: 706-653-0615
Mailing address:
  • Phone: 800-841-4236
  • Fax: 706-653-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DARIN WISWELL
Title or Position: CEO
Credential:
Phone: 440-989-4480