NPIMap

Organization Active NPI

Russell L. Carlisle, D.O.

  • Primary Care Clinic/Center
  • Brandon, MS
National Provider Identifier
1528459526
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
15093 Issued in MS
Legal business name
RUSSELL L. CARLISLE, D.O.
Practice address
333 Willow Ridge CV
Brandon, MS 39047-8089
Phone
(601) 757-5791
NPI assigned
Feb 11, 2015
Last updated
Feb 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

Name
Dr. Russell Carlisle, D.O.NPI 1689263717
Title
Owner
Phone
(601) 757-5791

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 15093 MS Primary

Addresses

Primary practice location

333 Willow Ridge CV
Brandon, MS 39047-8089

Mailing address

333 Willow Ridge CV
Brandon, MS 39047-8089
Phone (601) 757-5791

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1528459526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 WILLOW RIDGE CV",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390478089",
            "telephone_number": "601-757-5791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WILLOW RIDGE CV",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390478089",
            "telephone_number": "601-757-5791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL L. CARLISLE, D.O.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-757-5791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "15093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.