Organization
RUSSELLVILLE PHYSICIAN PRACTICES LLC
Active
Other names
Bankhead General Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD BIVACCA (PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
523 GANDY ST NE, SUITE E, RUSSELLVILLE, AL 35653-1961
(256) 331-1449
(256) 331-5182
Mailing address
523 GANDY ST NE, SUITE E, RUSSELLVILLE, AL 35653-1961
(256) 331-1449
(256) 331-5182
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17151
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AL
Enumeration date
10/04/2010
Last updated
10/04/2010
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