MEDICARE: RUSSELLVILLE PHYSICIANS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	31191	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215219134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUSSELLVILLE PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 1216
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1999
Country	:	US
Telephone Number	:	256-331-5828
Fax Number	:	256-331-5829

Provider Business Practice Location Address
First Line	:	15225 HIGHWAY 43
Second Line	:	SUITE B
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1999
Country	:	US
Telephone Number	:	256-331-5828
Fax Number	:	256-331-5829

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHRISTINE STEWART
Credential	:
Telephone Number	:	256-332-8679

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	06/25/2015

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Directions to “RUSSELLVILLE PHYSICIANS LLC ” Practice Location

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