Organization
RUSSELL MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD H. RUSSELL M.D. (OWNER/PHYSICIAN)
(662) 534-2486
Entity
Organization
Contact information
Practice address
402 DOCTORS DR, NEW ALBANY, MS 38652-3109
(662) 534-2486
(662) 534-2839
Mailing address
402 DOCTORS DR, NEW ALBANY, MS 38652-3109
(662) 534-2486
(662) 534-2839
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
208D00000X
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015413
—
MS
01
—
C02872
MEDICARE GROUP
MS
Enumeration date
10/11/2007
Last updated
10/12/2007
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