Russell Dermatology of Conway, PLLC
NPI 1639134067ActiveOrganization· Dermatology· Conway, AR
Dermatology in Conway, Arkansas, registered in NPPES in April 2006. The authorized official on file is Jackie D. Russell, Bus/Office Mgr. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1639134067 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 19, 2006 |
| Last updated in NPPES | Oct 9, 2025 |
| Certified by provider | Oct 9, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | E1574 | AR |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AR) |
|---|
Other Dermatology providers in Conway
- 1407719594
- 1790384808
- 1245411891
- 1588643563
- 1114474723
- 1033198510
- 1457330011