Provider Demographics
NPI:1336114784
Name:LARRY J RUSSELL
Entity Type:Organization
Organization Name:LARRY J RUSSELL
Other - Org Name:HENDERSONVILLE ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-5781
Mailing Address - Street 1:1027 FLEMING STREET
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-692-5781
Mailing Address - Fax:828-696-8606
Practice Address - Street 1:1027 FLEMING STREET
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-692-5781
Practice Address - Fax:828-696-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891772513OtherNPI
2322577AOtherMEDICARE
NC89016T5Medicaid