Provider Demographics
NPI:1871706127
Name:RUSSELL B ALLISON MD PA
Entity type:Organization
Organization Name:RUSSELL B ALLISON MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:PARIS
Authorized Official - Last Name:HEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-890-9292
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-890-9292
Mailing Address - Fax:479-890-6962
Practice Address - Street 1:1605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2719
Practice Address - Country:US
Practice Address - Phone:479-890-9292
Practice Address - Fax:479-890-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154927716Medicaid