NPIMap

Organization Active NPI

Russellville Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Russellville, AL
National Provider Identifier
1649442369
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
27647 Issued in AL
Legal business name
RUSSELLVILLE PHYSICIAN PRACTICES LLC
Doing business as
Azalea OBGYN
Practice address
523 Gandy St NE
Suite F
Russellville, AL 35653-1961
Phone
(256) 331-3988
Fax
(256) 331-3987
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

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

Authorized official

Name
William M. Gracey
Title
Coo
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 27647 AL Primary

Addresses

Primary practice location

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

Mailing address

PO Box 270
Russellville, AL 35653-0270
Phone (256) 331-3988

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Other names 1

  • Azalea OBGYN Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1649442369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356530270",
            "telephone_number": "256-331-3988",
            "fax_number": "256-331-3987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 GANDY ST NE",
            "address_2": "SUITE F",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531961",
            "telephone_number": "256-331-3988",
            "fax_number": "256-331-3987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE PHYSICIAN PRACTICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "GRACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "AL",
            "license": "27647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Azalea OBGYN",
            "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 Jun 6, 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.