| Warren K Russell Ph D P C | |
|
717 Nw 56th St Oklahoma City OK 73118-6030 | |
| (405) 415-2302 | |
| (405) 415-2301 |
| Full Name | Warren K Russell Ph D P C |
|---|---|
| Speciality | Psychologist |
| Location | 717 Nw 56th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Warren K Russell (PRESIDENT) |
| Authorized Official Contact | 4054152302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Warren K Russell Ph D P C 717 Nw 56th St Oklahoma City OK 73118-6030 Ph: (405) 415-2302 | Warren K Russell Ph D P C 717 Nw 56th St Oklahoma City OK 73118-6030 Ph: (405) 415-2302 |
| NPI Number | 1417019522 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 03/05/2008 |
| Medicare PECOS PAC ID | 5597770792 |
|---|---|
| Medicare Enrollment ID | O20060209000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417019522 | NPI | - | NPPES |
| 442526116001 | Other | OK | BCBS OF OKLAHOMA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 753 (Oklahoma) | Primary |
| Provider Name | Warren K Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790728871 PECOS PAC ID: 4385688076 Enrollment ID: I20050614000446 |
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