Provider Demographics
NPI:1679768311
Name:RUSSELL COUNTY COMMUNITY HOSPITAL, LLC
Entity Type:Organization
Organization Name:RUSSELL COUNTY COMMUNITY HOSPITAL, LLC
Other - Org Name:SUMMIT HOSPITAL ER PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:334-732-3458
Mailing Address - Street 1:4401 RIVER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7483
Mailing Address - Country:US
Mailing Address - Phone:334-732-3000
Mailing Address - Fax:334-732-3020
Practice Address - Street 1:4401 RIVER CHASE DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7483
Practice Address - Country:US
Practice Address - Phone:334-732-3000
Practice Address - Fax:334-732-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH5703207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty