Elkhart Neurology PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

02001219 Issued in IN

Legal business name

ELKHART NEUROLOGY PC

Practice address

2746 Old US 20 W
Suite a
Elkhart, IN 46514-1364

Phone

(574) 522-7624

Fax

(574) 522-9405

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Patrick W Russell, DO

Title

President

Phone

(574) 522-7624

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1306976717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2746 OLD US 20 W",
            "address_2": "SUITE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141364",
            "telephone_number": "574-522-7624",
            "fax_number": "574-522-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2746 OLD US 20 W",
            "address_2": "SUITE A",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141364",
            "telephone_number": "574-522-7624",
            "fax_number": "574-522-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHART NEUROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-522-7624",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IN",
            "license": "02001219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100114080B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elkhart General Hospital, Inc.
• Elkhart General Hospital, Inc.
• Elkhart General Hospital, Inc.
• Elkhart General Hospital, Inc.
• Elkhart General Hospital, Inc.
• Elkhart Ophthalmology, LLC
• Elkhart Oral and Maxillofacial Surgery Inc.
• Elkhart Pediatric Dentistry LTD
• Elkhart Place Assisted Living LLC
• Elkhart Podiatry Clinic, P.C.

• Neurology Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Neurology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; 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.