NPIMap

Organization Active NPI

Russellville Physician Practices LLC

  • Surgery Physician
  • Russellville, AL
National Provider Identifier
1528377983
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
17151 Issued in AL
Legal business name
RUSSELLVILLE PHYSICIAN PRACTICES LLC
Doing business as
Bankhead General Surgery
Practice address
523 Gandy St NE
Suite E
Russellville, AL 35653-1961
Phone
(256) 331-1449
Fax
(256) 331-5182
NPI assigned
Oct 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

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

Authorized official

Name
Mr. Donald Bivacca
Title
President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 17151 AL Primary

Addresses

Primary practice location

523 Gandy St NE
Suite E
Russellville, AL 35653-1961

Mailing address

523 Gandy St NE
Suite E
Russellville, AL 35653-1961
Phone (256) 331-1449

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Other names 1

  • Bankhead General Surgery Doing business as

National Provider Directory

National Provider Directory

Locations

523 Gandy St NE
Ste E
Russellville, AL 35653
Phone (256) 331-1449

NPI Registry JSON

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

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286150400000",
    "number": "1528377983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 GANDY ST NE",
            "address_2": "SUITE E",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531961",
            "telephone_number": "256-331-1449",
            "fax_number": "256-331-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 GANDY ST NE",
            "address_2": "SUITE E",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531961",
            "telephone_number": "256-331-1449",
            "fax_number": "256-331-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-04",
        "last_updated": "2010-10-04",
        "status": "A",
        "authorized_official_last_name": "BIVACCA",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "AL",
            "license": "17151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bankhead General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; 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.