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General NPI Number Information
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NPI Number | 1205024452
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Entity Type | Organization
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Legal Business Name | RUSSELL MEDICAL CLINIC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 402 DOCTORS DR
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City | NEW ALBANY
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State | MS
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Zip | 38652-3109
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Country | US
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Telephone | 662-534-2486
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Fax | 662-534-2839
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Provider Business Mailing Address
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Address Line | 402 DOCTORS DR
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City | NEW ALBANY
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State | MS
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Zip | 38652-3109
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Country | US
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Telephone | 662-534-2486
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Fax | 662-534-2839
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. RICHARD H. RUSSELL
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Credential | M.D.
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Telephone | 662-534-2486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 208D00000X
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License Number State | MS
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