Provider Demographics
NPI:1063594539
Name:RUSSELLVILLE MUSCULOSKELETAL CENTER INC.
Entity type:Organization
Organization Name:RUSSELLVILLE MUSCULOSKELETAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAID
Authorized Official - Middle Name:GOTO
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-332-6215
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0057
Mailing Address - Country:US
Mailing Address - Phone:256-332-6215
Mailing Address - Fax:256-331-3430
Practice Address - Street 1:13150 HIGHWAY 43
Practice Address - Street 2:SUITE 12
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-4558
Practice Address - Country:US
Practice Address - Phone:256-332-6215
Practice Address - Fax:256-331-3430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27698207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALL026OtherMEDICARE IDENTIFICATION NUMBER
AL529930670Medicaid
ALL026OtherMEDICARE IDENTIFICATION NUMBER
ALF87078Medicare UPIN