# LARRY J RUSSELL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548234032
- **Authorized official:** LAURA H WARD (PRACTICE MANAGER)
- **Authorized official phone:** (828) 693-4431

## Contact information

- **Practice address:** 510 BALSAM RD, HENDERSONVILLE, NC 28792-5703
- **Practice address phone:** (828) 693-4431
- **Practice address fax:** (828) 693-4871
- **Mailing address:** 510 BALSAM RD, HENDERSONVILLE, NC 28792-5703
- **Mailing address phone:** (828) 693-4431
- **Mailing address fax:** (828) 693-4871

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8901249 | — | NC |
| 05 | — | NPB019 | — | SC |