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General NPI Number Information
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NPI Number | 1134594229
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Entity Type | Organization
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Legal Business Name | RUSSELL B ALLISON
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 5395 W ASH ST STE 1
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City | POTTSVILLE
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State | AR
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Zip | 72858-9228
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Country | US
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Telephone | 479-219-5034
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-1146
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Country | US
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Telephone | 479-890-9292
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Fax | 479-890-6962
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SABRINA PARIS TENCLEVE
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Credential |
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Telephone | 479-890-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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