MR. RUSSELL CARL WILSON (NPI# 1780675967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780675967 |
| Entity Type | Individual |
| Full Name | MR. RUSSELL CARL WILSON |
| Credential | P.A.-C, A.T.C. |
| Practice Address |
1101 W Eagle Dr Suite B Decatur TX 76234-3721 |
| Mailing Address |
5083 Hawk Springs Dr Colorado Springs CO 80923-5121 |
| Practice Telephone | 9406271770 |
| Practice Fax Number | 9406272233 |
| Mailing Telephone | 9402109793 |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2020-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 146L00000X | Emergency Medical Technician, Paramedic | 45448 | TX | Emergency Medical Service Providers |
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
020202111 | NE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 363A00000X | Physician Assistant | PA.0005767 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 1092900 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBSTX | 8029NH | 01 |
| TX | 360930704 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3455 Ringsby Ct Ste 102, Denver, CO 802164923 | 3035001518 | 7205980440 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205844230 | Russell Clayton Wilson | Dentist | 2738 W Main St, Visalia, CA 93291-4332 | 2006-08-04 |
| 1427057736 | Russell Andrew Wilson | Surgery | 1265 Highway 54 W Ste 500b, Fayetteville, GA 30214-4556 | 2005-07-19 |
| 1124068432 | Russell Chapman Wilson | Radiology | 3949 Browning Pl, Raleigh, NC 27609-6504 | 2006-06-07 |
| 1487636627 | Russell L. Wilson | Radiology | 1215 Duff Ave, Ames, IA 50010-3014 | 2005-11-15 |
| Street Address |
1101 W EAGLE DR SUITE B |
| City | DECATUR |
| State | TX |
| Zip Code | 76234-3721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891125530 | S & L Medical Center Pharmacy Inc | Pharmacy | 1101 W Eagle Dr, Suite C, Decatur, TX 76234-3721 | 2013-11-16 |
| 1134557697 | Chadwick M Lindt, D.d.s., P.C. | Dentist | 1101 W Eagle Dr, Ste. A, Decatur, TX 76234-3721 | 2013-10-21 |
| 1811137995 | Ribeiro Orthopedic Pa | Orthopaedic Surgery | 1101 W Eagle Dr, Suite B, Decatur, TX 76234-3721 | 2009-03-02 |
| 1487786091 | S & J Medical Center Pharmacy Inc | Pharmacy | 1101 W Eagle Dr, Suite C, Decatur, TX 76234-3721 | 2007-03-09 |
| 1245295732 | John A Ribeiro | Orthopaedic Surgery | 1101 W Eagle Dr, Suite B, Decatur, TX 76234-3721 | 2006-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477102028 | Ursula Eileen Fernandez-plata | Technician | 1221 Cr 4371, Decatur, TX 76234 | 2019-09-06 |
| 1649772377 | Stephanie Jennie Roddenberry | Nurse Practitioner | 2301 S Fm 51 Ste 500, Decatur, TX 76234 | 2018-03-08 |
| 1467731679 | David Gatti Corless | Dentist | 301 W. Main St., Decatur, TX 76234 | 2011-08-05 |
| 1376830067 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 805 W Business Hwy 380, Decatur, TX 76234 | 2011-07-01 |
| 1356667844 | Richard Ryan Ooten | Specialist/Technologist, Other | 239 Harvey Lane, Decatur, TX 76234 | 2010-04-09 |
| 1003049032 | Advanced Gastroenterology Associates, Pa | Internal Medicine | 607 Medical Center Drive, Suite 2600, Decatur, TX 76234 | 2009-08-25 |
| 1831346188 | Rufus John Nelson | Dentist | 1710 S Hwy 51 Ste 20,pmb #176, 1000 W Business Hwy 380, Decatur, TX 76234 | 2008-08-19 |
| 1851558449 | James Lee Hendrick | Counselor | 2304 Fm 51 South, Decatur, TX 76234 | 2008-05-21 |
| 1891964995 | Sheryl A White | Counselor | 1106 E Business Hwy 380, Decatur, TX 76234 | 2008-02-22 |
| 1366625022 | Tower Mutual Holding Company, Inc. | Durable Medical Equipment & Medical Supplies | 206 N. State Street, Decatur, TX 76234 | 2007-12-17 |
| Find all providers in zip 76234 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598374860 | Lauren Nolan | Physician Assistant | 500 Irvin Ct # 200, Decatur, GA 30030-1705 | 2020-07-23 |
| 1134749930 | Elissa Stanton | Physician Assistant | 1280 Sanden Ferry Dr, Decatur, GA 30033-3346 | 2020-04-21 |
| 1902457138 | April Lynette Williams | Physician Assistant | 3669 Riverchase Ter, Decatur, GA 30034-4876 | 2019-09-29 |
| 1194389353 | Katherine Serafen | Physician Assistant | 2701 N Decatur Road, Ground Floor Suite 520, Decatur, GA 30033 | 2019-04-23 |
| 1124531249 | Carolina Espina | Physician Assistant | 2665 N Decatur Rd Ste 630, Decatur, GA 30033-6147 | 2017-11-10 |
| 1447703731 | Jessica Lin Brewer | Physician Assistant | 2186 Clairmont Rd, Decatur, GA 30033-1937 | 2016-08-03 |
| 1174972459 | Peter Bell | Physician Assistant | 2946 Clifton Springs Rd, Decatur, GA 30034-3820 | 2016-06-08 |
| 1902299597 | Farida Ahmadi | Physician Assistant | 200 E Ponce De Leon Ave Ste 110, Decatur, GA 30030-3467 | 2015-03-06 |
| 1730431313 | Daniel Lau | Physician Assistant | 2801 N. Decatur Road Suite 200, Decatur, GA 30033 | 2012-10-08 |
| 1720344302 | Kanwal Kapadia Lalani | Physician Assistant | 2665 N Decatur Rd Ste 430, Decatur, GA 30033-6145 | 2012-04-08 |
| Find all providers in DECATUR | ||||
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| 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.