Provider Demographics
NPI:1801018262
Name:RUSSELL OB-GYN CENTER FOR WOMEN A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RUSSELL OB-GYN CENTER FOR WOMEN A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-223-0682
Mailing Address - Street 1:8120 MAIN ST
Mailing Address - Street 2:STE. 302
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-223-0682
Mailing Address - Fax:985-223-0686
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:STE. 302
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-223-0682
Practice Address - Fax:985-223-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541753Medicaid
LAG74305Medicare UPIN
LA5A764Medicare ID - Type Unspecified