Provider Demographics
NPI:1427661743
Name:GARLINGHOUSE, RUSS C (SOIDC)
Entity type:Individual
Prefix:
First Name:RUSS
Middle Name:C
Last Name:GARLINGHOUSE
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SAGES RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-7994
Mailing Address - Country:US
Mailing Address - Phone:208-874-7637
Mailing Address - Fax:
Practice Address - Street 1:RR 616
Practice Address - Street 2:
Practice Address - City:STONE BAY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-440-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman