| Dr Thomas Gerald Russell Jr, MD | |
|
1099 Medical Center Cir, Mayfield, KY 42066-1159 | |
| (270) 251-4242 | |
| (270) 251-4240 |
| Full Name | Dr Thomas Gerald Russell Jr |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 1099 Medical Center Cir, Mayfield, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417080631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 27843 (Kentucky) | Primary |
| Entity Name | Southeastern Emergency Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356379382 PECOS PAC ID: 2466364997 Enrollment ID: O20050302000285 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Thomas Gerald Russell Jr, MD 934 State Route 2205, Mayfield, KY 42066-4886 Ph: (270) 247-9601 | Dr Thomas Gerald Russell Jr, MD 1099 Medical Center Cir, Mayfield, KY 42066-1159 Ph: (270) 251-4242 |
John Raymond Heiss, M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1099 Medical Center Cir, Mayfield, KY 42066 Phone: 270-251-4243 Fax: 270-251-4220 | |
Will Foston, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1099 Medical Center Cir, Mayfield, KY 42066 Phone: 931-906-4623 | |
Christa Monroe, NP Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1099 Medical Center Cir, Mayfield, KY 42066 Phone: 800-893-9698 | |
Pavan Bejgum, M.D Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 110 South 9th Street, Mayfield, KY 42066 Phone: 270-247-7795 Fax: 800-574-6540 |