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General NPI Number Information
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NPI Number | 1659712594
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE PHYSICIAN PRACTICES LLC
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 15225 HIGHWAY 43 SUITE I
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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 | 256-332-1533
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Fax |
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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 | 256-332-1533
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Fax |
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Authorized Official
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Title or Position | SR DIRECTOR
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Name | ANGIE MANGUM
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Credential |
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Telephone | 615-565-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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