Organization
LAKESHORE PEDIATRICS OF RUSSELLVILLE, PC
Active
Other names
dba Lakeshore Pediatric Rural Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA THOMPSON (DIRECTOR)
(256) 331-5055
Entity
Organization
Contact information
Practice address
603 GANDY ST NE, RUSSELLVILLE, AL 35653-1911
(256) 331-5055
(256) 460-4647
Mailing address
603 GANDY ST NE, RUSSELLVILLE, AL 35653-1911
(256) 331-5055
(256) 460-4647
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
AL
Other
Enumeration date
07/27/2010
Last updated
07/27/2010
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