Debra Russell, MD | |
18697 Bagley Rd, Middleburg Heights, OH 44130-3417 | |
(440) 816-8000 | |
Not Available |
Full Name | Debra Russell |
---|---|
Gender | Female |
Speciality | Emergency Medicine |
Location | 18697 Bagley Rd, Middleburg Heights, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1902847528 | NPI | - | NPPES |
930076090 | Other | OH | MEDICARE RR-GA |
942460636369 | Other | OH | CARESOURCE |
0689705 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 35052790W (Ohio) | Primary |
Entity Name | Southwest General Health Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1740608306 PECOS PAC ID: 7012909245 Enrollment ID: O20040330001464 |
Entity Name | Emergency Professional Services, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1093762353 PECOS PAC ID: 7214832435 Enrollment ID: O20040511000864 |
Mailing Address | Practice Location Address |
---|---|
Debra Russell, MD 1546 Deeplake Cir, Twinsburg, OH 44087-3336 Ph: () - | Debra Russell, MD 18697 Bagley Rd, Middleburg Heights, OH 44130-3417 Ph: (440) 816-8000 |
James Jos Rybak, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Phillip Stout, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Robert Brent Wilder, Emergency Medicine Medicare: Medicare Enrolled Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Ibrahim Hasan, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Michelle Ashley Fallon, DO Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Nicole Wadsworth, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 7123 Pearl Rd, Middleburg Heights, OH 44130 Phone: 440-842-7990 Fax: 440-842-8835 | |
Angel Ronda, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 |