RUSSELLVILLE GASTROENTEROLOGY CLINIC PA (NPI# 1750579488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750579488 |
| Entity Type | Organization |
| Organization Name | RUSSELLVILLE GASTROENTEROLOGY CLINIC PA |
| Practice Address |
1611 W Main St Russellville AR 72801-2719 |
| Practice Telephone | 4798905881 |
| Practice Fax Number | 4798905092 |
| Mailing Telephone | 4798905881 |
| Mailing Fax Number | 4798905092 |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2015-01-22 |
| Authorized Official Name | MS. DENISE ROBERTSON (OWNER) |
| Authorized Official Telephone | 4798905881 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
AR | Ambulatory Health Care Facilities | |
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
C6004 | AR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 112265001 | 05 |
| Street Address |
1611 W MAIN ST |
| City | RUSSELLVILLE |
| State | AR |
| Zip Code | 72801-2719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245345057 | Ronald Lynn White | Specialist | 1611 W Main St, Russellville, AR 72801-2719 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962002782 | Randy Paul Stayton | Pharmacist | 2109 W Main, Russellville, AR 72801 | 2020-10-30 |
| 1871134825 | Just Spreading Love Senior Care LLC | Student in an Organized Health Care Education/Training Program | 1411 N. Pittsburg Avenue, Russellville, AR 72801 | 2019-10-01 |
| 1124670369 | Richard L Morgan Dds Pa | Dentist | 1700 West C Place, Russellville, AR 72801 | 2019-07-09 |
| 1407342371 | Andrew James Hickman | Optometrist | 2711 E Parkway Drive, Russellville, AR 72801 | 2018-07-03 |
| 1154859833 | Felicia Head | Speech-Language Pathologist | 220 W 10th St., Russellville, AR 72801 | 2017-05-25 |
| 1295281293 | Arkansas Liver and Gastroenterology, P.a. | Internal Medicine | 1605 West Main Street, Russellville, AR 72801 | 2016-08-30 |
| 1467802405 | Kah Development 4, LLC | Hospice Care, Community Based | 3801 W Main St Ste A, Russellville, AR 72801 | 2016-06-21 |
| 1871904839 | Sleep Partners, LLC | Clinic/Center | 1310 West B Street, Suite A, Russellville, AR 72801 | 2014-05-13 |
| 1942647029 | Rpi Sleep Complete LLC | Clinic/Center | 1310 West Main Street, Suite 201, Russellville, AR 72801 | 2013-05-29 |
| 1184967291 | Amedco Arkansas Pllc | Optometrist | 302 N. Phoenix Ave., Clark Eye Clinic, Russellville, AR 72801 | 2013-03-27 |
| Find all providers in zip 72801 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1831464759 | Root's Chiropractic | Clinic/Center | 1403 Central Ave, Hot Springs, AR 71901-6149 | 2012-03-09 |
| 1619133394 | River Valley Urgent Care Pa | Clinic/Center | 3500 We Knight Drive, Fort Smith, AR 72903-6248 | 2008-08-01 |
| 1861612228 | North Arkansas Rheumatology, Plc | Clinic/Center | 123 Claude Parrish Ave, Harrison, AR 72601 | 2007-04-26 |
| 1073640769 | Bryant Family Medical Clinic, P.a. | Clinic/Center | 408 Office Park Dr Ste 3, Bryant, AR 72022-7536 | 2007-02-28 |
| 1114013349 | Paragould Urology | Clinic/Center | 1000 W Kingshighway Ste 8, Paragould, AR 72450-4197 | 2006-10-05 |
| 1588775464 | Wren & Barrow Ob Gyn Pllc Pa | Clinic/Center | 628 Hospital Dr Ste 2a, Mountain Home, AR 72653-2937 | 2006-08-31 |
| 1366450421 | Rehab and Pain Managment Clinic Inc. | Clinic/Center | 1201, Fleming Ave., Health South Rehablitation Hospital of Jonesboro, Jonesboro, AR 72403 | 2006-08-04 |
| 1952318099 | Prime Medical Imaging, A Division of Radiologists, P.a. | Clinic/Center | 320 S 9th St, Van Buren, AR 72956-5826 | 2006-08-02 |
| Find all providers with the same taxonomy | ||||
| City | RUSSELLVILLE |
| Zip Code | 72801 |
Please comment or provide details below to improve the information on RUSSELLVILLE GASTROENTEROLOGY CLINIC PA.
| 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.