Organization
LAKESHORE PEDIATRICS OF RUSSELLVILLE, PC
Active
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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