Ty Russell (NPI# 1487961322, PAC ID# 0143118026) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CHIROPRACTIC.
| Nation Provider ID (NPI) | 1487961322 |
| PAC ID by PECOS | 0143118026 |
| Professional Enrollment ID | I20110714000601 |
| Full Name | Ty Russell |
| Address |
207 Atlanta St Se Gravette AR 72736-9364 |
| Gender | M |
| Graduation Year | 1998 |
| Primary Specialty | CHIROPRACTIC |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 207 Atlanta St Se, Gravette, AR 72736-9364 |
| Street Address |
207 ATLANTA ST SE |
| City | GRAVETTE |
| State | AR |
| Zip | 72736-9364 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David Tucker | Family Medicine | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Kristi L Kroona | Certified Registered Nurse Anesthetist (crna) | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Nancy Jones | Family Medicine | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Tracy L Lowry | Nurse Practitioner | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Rayetta Eaton | General Practice | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Marty P. Witucki | Psychologist, Clinical | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Anita M Kane | Nurse Practitioner | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Robert D Hill | Family Medicine | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Charles Cantrell | Anesthesiology | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| David H Stacey | Plastic and Reconstructive Surgery | Sgoh Acquisition Inc | 1101 Jackson St Sw, Gravette, AR 72736-9121 |
| Find all physicians in zip 72736 | |||
| City | GRAVETTE |
| Zip Code | 72736 |
| Specialty | CHIROPRACTIC |
| City + Specialty | GRAVETTE + CHIROPRACTIC |
Please comment or provide details below to improve the information on Ty Russell.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.