An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Medical Specialty | 261QM2500X |
* Indicates primary specialty
| NPI Number | 1336114784 |
| Legal business name LBN |
LARRY J RUSSELL |
| Authorized official | LAURA WARD - (PRACTICE MANAGER) |
| Entity | Organization |
| Organization subpart | No |
| Enumeration date | 02/21/2006 |
| Last updated | 01/14/2008 - About 18 years ago |
| Sole proprietor1 | Not specified |
| Identifiers |
|
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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