Organization
RUSSELLVILLE PHYSICIAN PRACTICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD J BIVACCA (PRESIDENT)
(615) 920-7000
Entity
Organization
Contact information
Practice address
715 GANDY ST NE, RUSSELLVILLE, AL 35653-1922
(256) 332-1800
Mailing address
715 GANDY ST NE, RUSSELLVILLE, AL 35653-1922
(256) 332-1800
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529919480
—
AL
Enumeration date
08/24/2006
Last updated
08/17/2014
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