Provider Demographics
NPI:1043277007
Name:RUSSELL COUNTY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:RUSSELL COUNTY MEDICAL CENTER INC
Other - Org Name:RUSSELL COUNTY MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:276-883-8484
Mailing Address - Street 1:PO BOX 3600
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-0200
Mailing Address - Country:US
Mailing Address - Phone:276-883-8484
Mailing Address - Fax:276-883-8495
Practice Address - Street 1:116 FLANAGAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4514
Practice Address - Country:US
Practice Address - Phone:276-883-8484
Practice Address - Fax:276-883-8495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL COUNTY MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4970632Medicaid
VA497063Medicare Oscar/Certification