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General NPI Number Information
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NPI Number | 1215219134
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE PHYSICIANS LLC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 15225 HIGHWAY 43 SUITE B
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1999
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Country | US
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Telephone | 256-331-5828
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Fax | 256-331-5829
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Provider Business Mailing Address
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Address Line | P.O. BOX 1216
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1999
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Country | US
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Telephone | 256-331-5828
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Fax | 256-331-5829
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINE STEWART
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Credential |
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Telephone | 256-332-8679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 31191
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License Number State | AL
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