Provider Demographics
NPI:1861666075
Name:WRIGHT, RUSSELL LEE
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LEE
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-6161
Mailing Address - Country:US
Mailing Address - Phone:765-966-6308
Mailing Address - Fax:765-966-6308
Practice Address - Street 1:707 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6161
Practice Address - Country:US
Practice Address - Phone:765-966-6308
Practice Address - Fax:765-966-6308
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5615230001Medicare NSC