Provider Demographics
NPI:1831288117
Name:RUSSELL B ALLISON MDPA
Entity Type:Organization
Organization Name:RUSSELL B ALLISON MDPA
Other - Org Name:ARKANSAS ORTHOPAEDIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-890-9292
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-890-9292
Mailing Address - Fax:479-890-6962
Practice Address - Street 1:1605 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801
Practice Address - Country:US
Practice Address - Phone:479-890-9292
Practice Address - Fax:479-890-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X, 291U00000X
AR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150388002Medicaid
ARDA7424OtherPALMETTO RAILROAD
AR150388002Medicaid
ARDA7424OtherPALMETTO RAILROAD