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RUSSELLVILLE GASTROENTEROLOGY CLINIC PA
NPI 1750579488
Clinic/Center - Medical Specialty in Russellville, AR

Active since October 09, 2007
1611 W MAIN ST, RUSSELLVILLE, AR 72801(479) 890-5881(479) 890-5092 Get Directions Write a Review

NPPES record last updated: January 22, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Russellville Gastroenterology Clinic Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RUSSELLVILLE GASTROENTEROLOGY CLINIC PA (NPI 1750579488) is a healthcare organization registered as a medical specialty in Russellville, Arkansas and active in the NPI registry since October 2007. The organization lists Denise Robertson, Owner, as its authorized official.

NPPES Registry Identity

NPI1750579488
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameRUSSELLVILLE GASTROENTEROLOGY CLINIC PA
Location Address1611 W MAIN STRussellville, AR 72801-2719
Mailing Address1611 W Main StRussellville, AR 72801-2719 · (479) 890-5881 · Fax (479) 890-5092
Phone(479) 890-5881
Fax(479) 890-5092
Organization SubpartNo
Authorized OfficialDenise RobertsonOwner · (479) 890-5881
Enumeration DateOctober 9, 2007
Last NPPES UpdateJanuary 22, 2015
✔ NPI 1750579488 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in AR · C6004
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
1611 W MAIN ST, Russellville, AR 72801
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Other Identifiers 3

Medicare UPIND84067
Medicare UPIND84067AR
Medicaid112265001AR

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. RONALD LYNN WHITE M.D.
Specialist
1611 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 890-5881

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Russellville Gastroenterology Clinic PA's NPI number?

The NPI number for Russellville Gastroenterology Clinic PA is 1750579488. It was assigned to this organization in the NPPES registry on October 9, 2007.

Where is Russellville Gastroenterology Clinic PA located?

Russellville Gastroenterology Clinic PA is located at 1611 W Main St, Russellville, AR 72801. The listed phone number is (479) 890-5881.

What is Russellville Gastroenterology Clinic PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Russellville Gastroenterology Clinic PA was last updated on January 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.