Organization
RUSSELL COUNTY CLINIC CORP
Active
Parent organization
RUSSELL COUNTY CLINIC CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
RUSSELL COUNTY CLINIC CORP
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
58 CARROLL STREET, LEBANON, VA 24266
(276) 883-8470
(276) 883-8475
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(866) 398-7107
(615) 465-3007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
07/14/2006
Last updated
08/09/2007
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