NPIMap

Organization Active NPI

Russell Hospital Corporation

Doing business as Medical Park Family Care

  • Rural Health Clinic/Center
  • Dadeville, AL
National Provider Identifier
1215953799
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RUSSELL HOSPITAL CORPORATION
Doing business as
Medical Park Family Care
Practice address
1034 S Tallassee St
Dadeville, AL 36853-1844
Phone
(256) 825-9900
Fax
(256) 825-6620
NPI assigned
Jul 15, 2006
Last updated
Jul 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Lother E Peace III
Title
President/Ceo
Phone
(256) 329-7147

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 11873 AL
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1034 S Tallassee St
Dadeville, AL 36853-1844

Mailing address

1034 S Tallassee St
Dadeville, AL 36853-1844
Phone (256) 825-9900

Other identifiers 2

IdentifierTypeStateIssuer
CH4859OtherALRAILROAD MEDICARE
529906130MedicaidAL

Other names 1

  • Medical Park Family Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040109000579 AL Part B Supplier - Clinic/Group Practice 6406754431 Receives reassigned benefits from 41 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goodwater, AL; Dadeville, AL; Alexander City, AL
O20190712000891 AL Part A Provider - Rural Health Clinic 6406754431 Practice locations: Dadeville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215953799. Details of each certification follow.

Rural health clinic certification: CCN 013491

Legal name
RUSSELL HOSPITAL CORPORATION
Doing business as
MEDICAL PARK FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 18, 2020
Last certification
Aug 25, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 23, 1957 in AL
Enrollment address
1034 S Tallassee St
Dadeville, AL 36853-1844
Related CCNs
010065

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0981717Medical Park Family Care1034 South Tallassee Street, Dadeville, AL 36853ComplianceJun 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cancer Center at Russel5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1034 S Tallassee St
Dadeville, AL 36853
Phone (256) 825-9900

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lother Peace Individual Corporate DirectorPresident Jun 1, 2019
Operational/Managerial ControlPresident Jun 1, 2019

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1215953799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 S TALLASSEE ST",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368531844",
            "telephone_number": "256-825-9900",
            "fax_number": "256-825-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 S TALLASSEE ST",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368531844",
            "telephone_number": "256-825-9900",
            "fax_number": "256-825-6620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "PEACE",
        "authorized_official_first_name": "LOTHER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "256-329-7147",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "AL",
            "license": "11873",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH4859",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529906130",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Park Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dadeville, AL

Sources for this page

Verify at the official NPI Registry.