| James Russell, M.d, Inc. | |
|
308 S Main St Sapulpa OK 74066-4110 | |
| (918) 224-3081 | |
| (918) 224-5059 |
| Full Name | James Russell, M.d, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 308 S Main St, Sapulpa, Oklahoma |
| Authorized Official Name and Position | James Russell (PRESIDENT) |
| Authorized Official Contact | 9182243081 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| James Russell, M.d, Inc. 308 S Main St Sapulpa OK 74066-4110 Ph: (918) 224-3081 | James Russell, M.d, Inc. 308 S Main St Sapulpa OK 74066-4110 Ph: (918) 224-3081 |
| NPI Number | 1578786950 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 06/08/2010 |
| Medicare PECOS PAC ID | 0840315081 |
|---|---|
| Medicare Enrollment ID | O20100913000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578786950 | NPI | - | NPPES |
| 100134450B | Other | OK | SOONERCARE |
| 100134450A | Medicaid | OK | |
| 448463764001 | Other | OK | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 13810 (Oklahoma) | Primary |
| Provider Name | James Russell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508950379 PECOS PAC ID: 1951303650 Enrollment ID: I20100913000300 |
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