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General NPI Number Information
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NPI Number | 1033671631
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE HOSPITAL INC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 15225 HIGHWAY 43 STE I
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1969
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Country | US
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Telephone | 256-331-2700
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Fax | 256-331-2777
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Provider Business Mailing Address
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Address Line | PO BOX 1216
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1216
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Country | US
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Telephone | 256-331-2700
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Fax | 256-331-2777
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Authorized Official
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Title or Position | CEO
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Name | ASHOKE MUKHERJI
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Credential |
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Telephone | 256-332-8658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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