| Russellville Internal Medicine Pc | |
|
535 Gandy St Ne Russellville AL 35653-1965 | |
| (256) 332-1120 | |
| (256) 332-1198 |
| Full Name | Russellville Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 535 Gandy St Ne, Russellville, Alabama |
| Authorized Official Name and Position | Miranda Decker (MD) |
| Authorized Official Contact | 2563321120 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russellville Internal Medicine Pc Po Box 516 Russellville AL 35653-0516 Ph: (256) 332-1120 | Russellville Internal Medicine Pc 535 Gandy St Ne Russellville AL 35653-1965 Ph: (256) 332-1120 |
| NPI Number | 1174715296 |
|---|---|
| Provider Enumeration Date | 08/13/2007 |
| Last Update Date | 08/13/2007 |
| Medicare PECOS PAC ID | 4486747094 |
|---|---|
| Medicare Enrollment ID | O20070912000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174715296 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 28146 (Alabama) | Primary |
| Provider Name | Miranda Decker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699967612 PECOS PAC ID: 1759474364 Enrollment ID: I20070912000237 |
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