NPIMap

Organization Active NPI

Russell County Clinic Corp

  • Surgery Physician
  • Lebanon, VA
National Provider Identifier
1285650374
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
RUSSELL COUNTY CLINIC CORP
Practice address
58 Carroll Street
Lebanon, VA 24266
Phone
(276) 883-8470
Fax
(276) 883-8475
NPI assigned
Jul 14, 2006
Organization subpart
Yes
Parent organization
RUSSELL COUNTY CLINIC CORPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Authorized official

Name
Debbie T Brewer
Title
Director of Provider Enrollment
Phone
(877) 892-9813

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

58 Carroll Street
Lebanon, VA 24266

Mailing address

7100 Commerce Way
Suite 180
Brentwood, TN 37027-2829
Phone (866) 398-7107

National Provider Directory

National Provider Directory
Part of
CHS Russel Co Employed

Locations

81 S Flannagan Ave
Lebanon, VA 24266
Phone (276) 883-8029

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186617600000",
    "number": "1285650374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 COMMERCE WAY",
            "address_2": "SUITE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272829",
            "telephone_number": "866-398-7107",
            "fax_number": "615-465-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 CARROLL STREET",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "24266",
            "telephone_number": "276-883-8470",
            "fax_number": "276-883-8475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL COUNTY CLINIC CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUSSELL COUNTY CLINIC CORP",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-08-09",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.