Provider Demographics
NPI:1215953799
Name:THE RUSSELL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:THE RUSSELL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOTHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:256-329-7147
Mailing Address - Street 1:1034 S TALLASSEE ST
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-1844
Mailing Address - Country:US
Mailing Address - Phone:256-825-9900
Mailing Address - Fax:256-825-6620
Practice Address - Street 1:1034 S TALLASSEE ST
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-1844
Practice Address - Country:US
Practice Address - Phone:256-825-9900
Practice Address - Fax:256-825-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11873261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCH4859OtherRAILROAD MEDICARE
AL529906130Medicaid
AL529906130Medicaid