Provider Demographics
NPI:1306980412
Name:RUSSELL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:RUSSELL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-329-7147
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35011-0939
Mailing Address - Country:US
Mailing Address - Phone:256-329-7109
Mailing Address - Fax:256-329-7617
Practice Address - Street 1:3316 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3369
Practice Address - Country:US
Practice Address - Phone:256-329-7109
Practice Address - Fax:256-329-7617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11873207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529807150Medicaid
AL558200650Medicaid
ALC882Medicare ID - Type UnspecifiedRMC PHYSICIANS
AL558200650Medicaid