Provider Demographics
NPI:1790865749
Name:MOUNTS, RUSSELL A (PA-C)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:MOUNTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3975 EMBASSY PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8320
Mailing Address - Country:US
Mailing Address - Phone:330-668-4040
Mailing Address - Fax:330-668-4078
Practice Address - Street 1:3975 EMBASSY PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8320
Practice Address - Country:US
Practice Address - Phone:330-668-4040
Practice Address - Fax:330-668-4078
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000600RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA11301Medicare PIN