| Dr Trent K Russell, MD | |
|
1057 Medical Park Dr, Suite A, Osage Beach, MO 65065-3050 | |
| (573) 348-2745 | |
| (573) 348-8279 |
| Full Name | Dr Trent K Russell |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 1057 Medical Park Dr, Osage Beach, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134115744 | NPI | - | NPPES |
| 208072900 | Medicaid | MO | |
| 370013633 | Other | MO | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 107627 (Missouri) | Primary |
| Entity Name | Lake Regional Health System |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1053581454 PECOS PAC ID: 9133026776 Enrollment ID: O20070511000147 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Trent K Russell, MD 54 Hospital Dr, Osage Beach, MO 65065-3050 Ph: () - | Dr Trent K Russell, MD 1057 Medical Park Dr, Suite A, Osage Beach, MO 65065-3050 Ph: (573) 348-2745 |
Dr. Maria E. Bernabe, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 931 Highway D, Osage Beach, MO 65065 Phone: 573-392-5606 | |
Dr. Whitney L. Cline, DO Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 3870 Columbia Ave, Osage Beach, MO 65065 Phone: 573-302-7490 | |
Jacqueline E Santamarina, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-302-2287 Fax: 573-302-2241 | |
Dr. Geetha G. Herath, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-348-8000 Fax: 573-348-8069 | |
Parker Trent Russell, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-302-2287 Fax: 573-302-2241 | |
Kristen Anne Theobald-hazel, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 1057 Medical Park Dr, Osage Beach, MO 65065 Phone: 573-302-3100 Fax: 573-348-8279 |