Dr Trent K Russell, MD | |
1057 Medical Park Dr, Suite A, Osage Beach, MO 65065-3050 | |
(573) 348-2745 | |
(573) 348-8279 |
Full Name | Dr Trent K Russell |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 1057 Medical Park Dr, Osage Beach, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134115744 | NPI | - | NPPES |
208072900 | Medicaid | MO | |
370013633 | Other | MO | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 107627 (Missouri) | Primary |
Entity Name | Lake Regional Health System |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1053581454 PECOS PAC ID: 9133026776 Enrollment ID: O20070511000147 |
Mailing Address | Practice Location Address |
---|---|
Dr Trent K Russell, MD 54 Hospital Dr, Osage Beach, MO 65065-3050 Ph: () - | Dr Trent K Russell, MD 1057 Medical Park Dr, Suite A, Osage Beach, MO 65065-3050 Ph: (573) 348-2745 |
Dr. Maria E. Bernabe, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 931 Highway D, Osage Beach, MO 65065 Phone: 573-392-5606 | |
Dr. Whitney L. Cline, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 3870 Columbia Ave, Osage Beach, MO 65065 Phone: 573-302-7490 | |
Jacqueline E Santamarina, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-302-2287 Fax: 573-302-2241 | |
Dr. Geetha G. Herath, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-348-8000 Fax: 573-348-8069 | |
Parker Trent Russell, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 54 Hospital Dr, Osage Beach, MO 65065 Phone: 573-302-2287 Fax: 573-302-2241 | |
Kristen Anne Theobald-hazel, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 1057 Medical Park Dr, Osage Beach, MO 65065 Phone: 573-302-3100 Fax: 573-348-8279 |