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General NPI Number Information
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NPI Number | 1740661354
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Entity Type | Organization
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Legal Business Name | ELITE EMERGENCY RUSSELLVILLE PLLC
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 12 CADILLAC DR SUITE 150
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City | BRENTWOOD
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State | TN
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Zip | 37027-5272
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Country | US
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Telephone | 615-928-6275
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Fax | 615-760-5985
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Provider Business Mailing Address
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Address Line | 12 CADILLAC DR SUITE 150
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City | BRENTWOOD
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State | TN
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Zip | 37027-5272
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Country | US
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Telephone | 615-928-6275
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Fax | 615-760-5985
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MR. CHAD SOMERBY
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Credential |
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Telephone | 615-928-6275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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