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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
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
163WG0000X
General Practice Registered Nurse
163WH0200X
Home Health Registered Nurse
163WI0500X
Infusion Therapy Registered Nurse
163WP0808X
Psychiatric/Mental Health Registered Nurse
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
2084P0800X
Psychiatry Physician
2084P0802X
Addiction Psychiatry Physician
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LP2300X
Primary Care Nurse Practitioner
Primary

Other

Enumeration date
11/15/2020
Last updated
11/15/2020
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