Provider Demographics
NPI: | 1063634574 |
---|---|
Name: | RUSSELLVILLE PHYSICIAN PRACTICES LLC |
Entity Type: | Organization |
Organization Name: | RUSSELLVILLE PHYSICIAN PRACTICES LLC |
Other - Org Name: | EDWARD H FISHER MD |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | GRACEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-372-8500 |
Mailing Address - Street 1: | PO BOX 759 |
Mailing Address - Street 2: | |
Mailing Address - City: | RUSSELLVILLE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35653 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 256-332-1800 |
Mailing Address - Fax: | 256-332-1815 |
Practice Address - Street 1: | 715 GANDY STREET NE |
Practice Address - Street 2: | SUITE B |
Practice Address - City: | RUSSELLVILLE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35653 |
Practice Address - Country: | US |
Practice Address - Phone: | 256-332-1800 |
Practice Address - Fax: | 256-332-1815 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-03 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty |