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NPI Code Detail

MEDICARE: DRS RUSSELL BERKEBILE AND ASSOCIATES INC

MEDICARE: DRS RUSSELL BERKEBILE AND ASSOCIATES INC
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1750383519
Entity Type Code : Organization
Provider Name (Legal Business Name) : DRS RUSSELL BERKEBILE AND ASSOCIATES INC
Provider Business Mailing Address
First Line : PO BOX 678950
Second Line :
City : DALLAS
State : TX
Zip : 75267-8950
Country : US
Telephone Number : 800-841-4236
Fax Number : 706-653-0615
Provider Business Practice Location Address
First Line : 272 BENEDICT AVE
Second Line :
City : NORWALK
State : OH
Zip : 44857-2374
Country : US
Telephone Number : 419-734-3131
Fax Number : 706-653-0615
Authorized Official
Title or Position : CEO
Name : MR. DARIN WISWELL
Credential :
Telephone Number : 440-989-4480
Provider Enumeration Date : 08/11/2005
Last Update Date : 06/06/2024

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