Organization
RUSSMANN, INC.
Active
Other names
Tennessee MedPort
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA RUSSELL BODEMANN (PRINCIPAL)
(865) 414-2779
Entity
Organization
Contact information
Practice address
4163 BENNY DELOZIER DRIVE, MARYVILLE, TN 37804
(865) 379-9850
Mailing address
4163 BENNY DELOZIER DRIVE, MARYVILLE, TN 37804
(865) 379-9850
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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