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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 | Specialty Code | Provider Type | |
Medical Specialty |
261QM2500X |
| NPI # | 1336114784 |
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| LBN Legal business name | LARRY J RUSSELL | ||||||||||||
| Authorized official | LAURA WARD - (PRACTICE MANAGER) | ||||||||||||
| Entity | Organization | ||||||||||||
| Organization subpart 1 | No | ||||||||||||
| Enumeration date | 02/21/2006 | ||||||||||||
| Last updated | 01/14/2008 - About 18 years ago | ||||||||||||
| Identifiers |
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LARRY J RUSSELL
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LARRY J RUSSELL