| The Russell Hospital Corporation | |
|
12761 Highway 22 East New Site AL 36256 | |
| (256) 329-7100 | |
| Not Available |
| Full Name | The Russell Hospital Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 12761 Highway 22 East, New Site, Alabama |
| Authorized Official Name and Position | Lother E Peace (PRESIDENT/CEO) |
| Authorized Official Contact | 2563297100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Russell Hospital Corporation Po Box 939 Alexander City AL 35011-0939 Ph: (256) 329-7100 | The Russell Hospital Corporation 12761 Highway 22 East New Site AL 36256 Ph: (256) 329-7100 |
| NPI Number | 1700419868 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 02/13/2024 |
| Medicare PECOS PAC ID | 6406754431 |
|---|---|
| Medicare Enrollment ID | O20210225001208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700419868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Tammy R Coker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831573831 PECOS PAC ID: 8628378353 Enrollment ID: I20160119002384 |
| Provider Name | Justin Vines |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295147932 PECOS PAC ID: 1557675261 Enrollment ID: I20160818002444 |
| Provider Name | Jamie H Peavy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679023071 PECOS PAC ID: 9436438983 Enrollment ID: I20161128001371 |
| Provider Name | Erin Dean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598411050 PECOS PAC ID: 7618353160 Enrollment ID: I20221006000876 |