Provider Demographics
NPI:1114162435
Name:RUSSELL HARMS DPM PC
Entity Type:Organization
Organization Name:RUSSELL HARMS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-448-9290
Mailing Address - Street 1:1214 E NATIONAL AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2700
Mailing Address - Country:US
Mailing Address - Phone:812-448-9290
Mailing Address - Fax:812-448-9296
Practice Address - Street 1:1214 E NATIONAL AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2700
Practice Address - Country:US
Practice Address - Phone:812-448-9290
Practice Address - Fax:812-448-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000207213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200938770Medicaid
IN259500Medicare PIN
IN6206650001Medicare NSC