MARY RUSSO


Address: 400 W 16th St, Pueblo, CO 81003-2745
Phone: (719) 584-4306

MARY RUSSO (NPI# 1023421864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1023421864
Entity Type Individual
Full Name MARY RUSSO
Credential DO
Practice Address 400 W 16th St
Pueblo
CO 81003-2745
Practice Telephone (719) 584-4306
Practice Fax Number 7195957886
Mailing Telephone (719) 584-4306
Mailing Fax Number 7195957886
Enumeration Date 2014-06-10
Last Update Date 2018-03-17
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207P00000X Emergency Medicine DR.0058320 CO Allopathic & Osteopathic Physicians
N 207P00000X Emergency Medicine 5101021285 MI Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program 5101021285 MI Student, Health Care

Provider Secondary Practice Location

Address Telephone Number Fax Number
1000 Oakland Dr, Kalamazoo, MI 490081282 2693374400

Other Providers MARY RUSSO

NPI Name Taxonomy Address Enumeration
1962703587 Mary R Russo Registered Nurse 603 Willow Ave, Ithaca, NY 14850-3555 2010-11-12
1275851404 Mary Helen Russo Audiologist 750 N Ocean Blvd, # 602, Pompano Beach, FL 33062-4644 2010-05-12
1003049230 Mary Kathleen Russo Occupational Therapist 3775 Country Ln, Brownsburg, IN 46112-8375 2009-09-04
1689880619 Mary Russo Marriage & Family Therapist 137 E Hamilton Ave Ste 207, Campbell, CA 95008-0244 2007-05-15
1982970935 Mary M Russo Case Manager/Care Coordinator 420 Magnolia St, Houma, LA 70360-6304 2012-03-23
1225299381 Mary Elizabeth Russo Physician Assistant 540 Union Blvd, West Islip, NY 11795-3105 2008-06-21
1134304967 Mary Frances Russo Psychologist 100 State St, Suite 202, Erie, PA 16507-1454 2007-12-28
1710030234 Mary Kathleen Russo Dentist 804 Highway 71, Sea Girt, NJ 08750-2807 2007-01-19
1205922382 Mary Russo Dietitian, Registered 750 E Adams St, Syracuse, NY 13210-2306 2006-10-05

Office Location

Street Address 400 W 16TH ST
City PUEBLO
State CO
Zip Code 81003-2745

Providers in the same location

NPI Name Taxonomy Address Enumeration
1992700694 James E Caldwell Anesthesiology 400 W 16th St, Pueblo, CO 81003-2745 2005-06-17
1174137806 Pediatrix Medical Group of Colorado, P.C. Pediatrics 400 W 16th St, Pueblo, CO 81003-2745 2020-09-01
1992327217 Kristina Reavis Nurse Practitioner 400 W 16th St, Pueblo, CO 81003-2781 2020-05-08
1881214567 Nathan S Grigg Student in an Organized Health Care Education/Training Program 400 W 16th St, Pueblo, CO 81003-2745 2020-04-22
1467083881 Erik Matthews Wickstrum Nurse Anesthetist, Certified Registered 400 W 16th St, Pueblo, CO 81003-2781 2020-02-04
1497385082 Sean Jastillano Nurse Anesthetist, Certified Registered 400 W 16th St, Pueblo, CO 81003-2745 2020-01-22
1417597287 Zainab Adeyemo Nurse Anesthetist, Certified Registered 400 W 16th St, Pueblo, CO 81003-2745 2020-01-09
1265071658 Victoria Louise Farnsworth Nurse Anesthetist, Certified Registered 400 W 16th St, Pueblo, CO 81003-2781 2020-01-02
1205479557 Brandis Courtney Montez Nurse Practitioner 400 W 16th St, Pueblo, CO 81003-2781 2019-10-18
1750923199 Catholic Health Initiatives Colorado Thoracic Surgery (Cardiothoracic Vascular Surgery) 400 W 16th St, Pueblo, CO 81003-2745 2019-10-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1164042016 Sunil Kumar Student in an Organized Health Care Education/Training Program Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 2020-04-21
1497382303 Pueblo Family Dentistry Pllc Dentist 701 N Grand Avenue, Suite B, Pueblo, CO 81003 2020-03-23
1023654241 Elmer A. Villalon, Dmd, LLC Clinic/Center 1225 North Main Street, #207, Pueblo, CO 81003 2019-11-22
1518434349 Mariam Rahim Internal Medicine Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 2018-10-30
1003308222 Julia Mcneice Internal Medicine Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 2018-06-04
1689164857 Jessica Sels Internal Medicine Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 2018-05-14
1700313459 Allison Vigil Occupational Therapist 1600 W. 24th St, Pueblo, CO 81003 2017-05-12
1245682020 Paul S Bongat Internal Medicine 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 2016-07-06
1013368596 Daniel R Long Internal Medicine 411 West 14th Street, Pueblo, CO 81003 2016-06-27
1396195665 Parkview Medical Center General Acute Care Hospital 411 W. 14th St, Pueblo, CO 81003 2016-06-17
Find all providers in zip 81003

Taxonomy Information

Taxonomy Code 207P00000X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine

Taxonomy Definition

An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source]
- Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1639496987 Natalie Marie Mosley Emergency Medicine 3676 Parker Blvd., Suite 280, Pueblo, CO 81008-2214 2010-04-27
1073522595 Teresa Kay Braden Emergency Medicine 311 W 14th St, Pueblo, CO 81003-2705 2006-08-05
1124086723 Michael Todd Duzan Emergency Medicine 401 W Northern Ave, Pueblo, CO 81004-3111 2006-05-03
1780664169 Roger W. Narvaez Emergency Medicine 1320 Fortino Blvd, Suite C, Pueblo, CO 81008-2081 2006-01-20
1447233432 Richard N. Nanes Emergency Medicine 4112 Outlook Blvd, Suite 37, Pueblo, CO 81008-1667 2005-11-22
1932735321 Usacs of Colorado Inc Emergency Medicine 1008 Minnequa Ave, Pueblo, CO 81004-3733 2020-03-17
1518499177 Samuel Grossman Emergency Medicine 400 W 16th St, Pueblo, CO 81003-2745 2017-03-31
1750737862 Trevor Wilson Halle Emergency Medicine 1008 Minnequa Ave, Pueblo, CO 81004-3733 2016-05-06
1225491384 Matthew Rodgers Emergency Medicine 400 W 16th St, Pueblo, CO 81003-2745 2016-04-05
1851753974 Benjamin Honig Emergency Medicine 400 W 16th St, Pueblo, CO 81003 2016-03-28
Find all providers in PUEBLO

Competitor

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City PUEBLO
Zip Code 81003

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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