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Organization
PROVIDERGENIX LLC
Active
Organization
PROVIDERGENIX LLC
Active
Other names
Providergenix Healthcare Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS LEE RUSSELL DNP, CNP, FNP-C (CEO)
(419) 406-0067
Entity
Organization
Contact information
Practice address
3100 E 45TH ST STE 234, CLEVELAND, OH 44127-1091
(419) 406-0067
(866) 309-3044
Mailing address
3100 E 45TH ST STE 234, CLEVELAND, OH 44127-1091
(419) 406-0067
(866) 309-3044
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
NULL
163W00000X
Registered Nurse
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
NULL
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
163WG0000X
General Practice Registered Nurse
—
NULL
163WG0000X
General Practice Registered Nurse
—
—
163WH0200X
Home Health Registered Nurse
—
NULL
163WH0200X
Home Health Registered Nurse
—
—
163WI0500X
Infusion Therapy Registered Nurse
—
NULL
163WI0500X
Infusion Therapy Registered Nurse
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
NULL
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2084P0802X
Addiction Psychiatry Physician
—
NULL
2084P0802X
Addiction Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/15/2020
Last updated
11/15/2020
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