CHARLES MARK RUSSELL (NPI# 1043218720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043218720 |
| Entity Type | Individual |
| Full Name | CHARLES MARK RUSSELL |
| Credential | PA |
| Practice Address |
6157 Nw Loop 410 Ste. 124 San Antonio TX 78238-3302 |
| Practice Telephone | 2105231411 |
| Practice Fax Number | 2105239307 |
| Mailing Telephone | 2105231411 |
| Mailing Fax Number | 2105239307 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2016-10-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00353 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | WELLMED MEDICAID | 312676501 | 01 |
| TX | WELLMED MEDICARE | TXB153718 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700486750 | Charles Mcpherrin Russell | Pharmacist | 6301 Nw Quannah Parker Trl, Lawton, OK 73505-1326 | 2020-10-29 |
| 1306336847 | Charles R Russell | Behavior Technician | 4520 S Huron St, Englewood, CO 80110-5636 | 2018-05-10 |
| 1245220912 | Charles E Russell | 579 Rustic Trl, Beavercreek, OH 45434-7337 | 2005-10-25 | |
| 1548264328 | Charles Mark Russell | Dentist | 163 Beech St, Harrogate, TN 37752-8208 | 2005-06-09 |
| 1457833626 | Charles William Russell | Psychologist | 8901 New Hampshire Ave, Silver Spring, MD 20903-3611 | 2018-09-04 |
| 1922539857 | Charles Rayfield Russell IIi | General Practice | 2001 Kingsley Ave, Orange Park, FL 32073-5148 | 2017-03-22 |
| 1043569940 | Charles R Russell | Chiropractor | 3555 Clares St, Suite Ww, Capitola, CA 95010-2555 | 2012-09-06 |
| 1568724003 | Charles Joseph Russell | Counselor | 315 N Lakemont Ave, Winter Park, FL 32792-3205 | 2012-06-11 |
| 1841404159 | Charles Edward Russell | Counselor | 1644 S College Ave, Fort Collins, CO 80525-1007 | 2007-05-09 |
| 1366575185 | Charles Russell | Case Manager/Care Coordinator | 2707 Browns Ln, Jonesboro, AR 72401-7213 | 2007-03-13 |
| Street Address |
6157 NW LOOP 410 STE. 124 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78238-3302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336146083 | Richard James Whittaker | Family Medicine | 6157 Nw Loop 410, Ste 124, San Antonio, TX 78238-3302 | 2005-07-07 |
| 1497102982 | Carvjals Inc. | Pharmacy | 6157 Nw Loop 410, San Antonio, TX 78238-3302 | 2016-05-16 |
| 1568607984 | Marissa G Charles | Family Medicine | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2008-12-15 |
| 1265694186 | Jose Lopez | Family Medicine | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2008-07-01 |
| 1487666475 | Marina Aldaco Crayton | Physician Assistant | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2006-08-12 |
| 1326071838 | Tanpraserth Vatanadilok | Nurse Practitioner | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2006-07-08 |
| 1427027036 | Mohammadullah Faiz | Family Medicine | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2006-03-16 |
| 1245237999 | John Thomas Bridgest | Physician Assistant | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2005-07-07 |
| 1932106630 | Joseph David Gonzalez | Family Medicine | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2005-07-07 |
| 1841297546 | Paul Daniel Garcia | Internal Medicine | 6157 Nw Loop 410, Ste. 124, San Antonio, TX 78238-3302 | 2005-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598383259 | Dialysis Clinic Inc. | Clinic/Center | 6146 Wurzbach Road, San Antonio, TX 78238 | 2020-07-09 |
| 1043857360 | Danielle Renee De Luna | Counselor | 5505 Lost Lane, San Antonio, TX 78238 | 2019-12-05 |
| 1013444777 | Avery Rodriguez | Physical Therapy Assistant | 5270 Bandera Rd Ste 14, San Antonio, TX 78238 | 2017-05-12 |
| 1760898894 | Silas Pimentel | Physical Therapist | 5720 Bandera Rd Ste 14, San Antonio, TX 78238 | 2014-07-09 |
| 1942550553 | Stanley Toh Forze | Registered Nurse | 6933 Border Brk Apt 1910, San Antonio, TX 78238 | 2012-09-12 |
| 1891004032 | Texan Smile Dentistry 3 PC | Dentist | 5983 Bandera Rd., San Antonio, TX 78238 | 2010-10-06 |
| 1275847683 | Deborah Michelle Solorzano | Dentist | 5715 Evers Road, San Antonio, TX 78238 | 2010-07-28 |
| 1932436326 | Campos Family Dental, P.C. | Dentist | 6140 Wurzbach Road, San Antonio, TX 78238 | 2009-11-06 |
| 1063665495 | Benjamino L Granato | Durable Medical Equipment & Medical Supplies | 6415 Bandera, San Antonio, TX 78238 | 2008-10-29 |
| 1891962262 | Gerald L Froemming | Dentist | 6436 Bandera Road, #1, San Antonio, TX 78238 | 2008-05-14 |
| Find all providers in zip 78238 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245870930 | Jessica Grimaldo | Physician Assistant | 1200 Brooklyn Ave Ste 230, San Antonio, TX 78212-0010 | 2020-01-09 |
| 1194210658 | 5 Star Integrity Healthcare, LLC | Physician Assistant | 1300 West Ave Ste 201, San Antonio, TX 78201-3501 | 2018-06-27 |
| 1245750512 | William S Beall Jr. | Physician Assistant | 230 E Travis St, San Antonio, TX 78205-1702 | 2017-06-27 |
| 1114473808 | Devon H. Durand | Physician Assistant | 7950 Floyd Curl Dr Ste 805, San Antonio, TX 78229-3926 | 2016-09-01 |
| 1538533104 | Dara Danielle Valdez | Physician Assistant | 2040 Babcock Rd Ste 301, San Antonio, TX 78229-4428 | 2015-11-19 |
| 1720458870 | Thomas Alan Espinoza | Physician Assistant | 1919 Rogers Rd Ste 104, San Antonio, TX 78251 | 2015-10-01 |
| 1477922474 | Michelle Sheree Fonseca | Physician Assistant | 9811 Huebner Rd Bldg 2, San Antonio, TX 78240-3255 | 2015-09-20 |
| 1235526575 | Precision First Assist LLC | Physician Assistant | 1141 N Loop 1604 E # 105-717, San Antonio, TX 78232-1339 | 2015-04-24 |
| 1497142160 | Jimmy Larue Conner | Physician Assistant | 2903 Deer Ledge, San Antonio, TX 78230-4554 | 2015-04-21 |
| 1740678317 | Catherine Millet | Physician Assistant | 730 N Main Ave Ste 312, San Antonio, TX 78205-1115 | 2015-01-05 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78238 |
Please comment or provide details below to improve the information on CHARLES MARK RUSSELL.
| 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.