Provider Demographics
NPI:1316785579
Name:RUSSELL, OSWALD SEYMOUR JR
Entity type:Individual
Prefix:
First Name:OSWALD
Middle Name:SEYMOUR
Last Name:RUSSELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2903
Mailing Address - Country:US
Mailing Address - Phone:614-594-3294
Mailing Address - Fax:
Practice Address - Street 1:545 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2903
Practice Address - Country:US
Practice Address - Phone:614-594-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty