Provider Demographics
NPI:1508491093
Name:RUSSELLVILLE HOSPITAL INC
Entity Type:Organization
Organization Name:RUSSELLVILLE HOSPITAL INC
Other - Org Name:RUSSELLVILLE HOSPITAL FAMILY CARE FIRST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-732-0768
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1216
Mailing Address - Country:US
Mailing Address - Phone:256-331-2770
Mailing Address - Fax:256-331-2777
Practice Address - Street 1:13150 HIGHWAY 43 STE 10
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-4566
Practice Address - Country:US
Practice Address - Phone:256-332-5901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty