Russell W Poe, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DS020113L Issued in PA

Practice address

83 Shenango St
Greenville, PA 16125

Phone

(724) 588-3010

Fax

(724) 588-3011

NPI assigned

Mar 27, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073631859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 SHENANGO ST",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "16125",
            "telephone_number": "724-588-3010",
            "fax_number": "724-588-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 SHENANGO ST",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "16125",
            "telephone_number": "724-588-3010",
            "fax_number": "724-588-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POE",
        "first_name": "RUSSELL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS020113L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005126620001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcia Lynn Petrick, MD
• Constantine N Petrochko, MD
• Cathy Petty, PT
• Colleen Ann Pickens, PTA
• Scott F Pickering, MD
• Kerry Polis
• Kevin A. Polkabla, PT
• Michelle Nicolette Porembka, PA-C
• Jonathan Seth Porter, PTA
• Tracy A. Powell

• Dentist in Greenville, PA
• Providers in Greenville, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.