Provider Demographics
NPI:1780680215
Name:RUSSELL COUNTY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:RUSSELL COUNTY MEDICAL CENTER, INC
Other - Org Name:RUSSELL COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, COMMUNITY HEALTH SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-373-9600
Mailing Address - Street 1:PO BOX 198250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:58 CARROLL STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL COUNTY MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1892275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49U002Medicare Oscar/Certification