Organization Name: | RUSSELLVILLE HOLDINGS LLC |
NPI Number: | 1932150943 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | S. RAY COFFEY (VP, REIMBURSEMENT) |
Mailing Address: | 11720 Sr 27 Hector |
State: | AR US |
Postal Code: | 728438712 |
Phone Number: | 4792845001 |
Fax Number: | 4792844210 |
NPI Enumeration Date: | 05/14/2006 |
NPI Last Update Date: | 06/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | A001233 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |