Individual
CHARLES MARK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6157 NW LOOP 410, STE. 124, SAN ANTONIO, TX 78238-3302
(210) 523-1411
(210) 523-9307
Mailing address
6157 NW LOOP 410, STE. 124, SAN ANTONIO, TX 78238-3302
(210) 523-1411
(210) 523-9307
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00353
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312676501
WELLMED MEDICAID
TX
01
—
TXB153718
WELLMED MEDICARE
TX
Enumeration date
07/07/2005
Last updated
10/18/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us