Provider Demographics
NPI:1922003730
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:276-883-8000
Mailing Address - Fax:276-889-4336
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1892282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN490002OtherBLUE CARE TN MEDICAID IP
TN1868Medicaid
VA007676OtherBLUE CROSS
TN3101497OtherBLUE CARE TN MEDICAID OP
A2426600OtherFEDERAL BLACK LUNG
WV0170863000Medicaid
VA490002Medicare Oscar/Certification