Provider Demographics
NPI:1477066264
Name:CLAIRE RUSSELL FAMILY MEDICAL CENTER PLLC
Entity Type:Organization
Organization Name:CLAIRE RUSSELL FAMILY MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-293-7093
Mailing Address - Street 1:300 W COLLIN RAYE DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2003
Mailing Address - Country:US
Mailing Address - Phone:903-280-2813
Mailing Address - Fax:
Practice Address - Street 1:300 W COLLIN RAYE DR STE 101B
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2003
Practice Address - Country:US
Practice Address - Phone:903-280-2813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty