MARY RUSSO (NPI# 1023421864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023421864 |
| Entity Type | Individual |
| Full Name | MARY RUSSO |
| Credential | DO |
| Practice Address |
400 W 16th St Pueblo CO 81003-2745 |
| Practice Telephone | (719) 584-4306 |
| Practice Fax Number | 7195957886 |
| Mailing Telephone | (719) 584-4306 |
| Mailing Fax Number | 7195957886 |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | DR.0058320 | CO | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | 5101021285 | MI | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | 5101021285 | MI | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1000 Oakland Dr, Kalamazoo, MI 490081282 | 2693374400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962703587 | Mary R Russo | Registered Nurse | 603 Willow Ave, Ithaca, NY 14850-3555 | 2010-11-12 |
| 1275851404 | Mary Helen Russo | Audiologist | 750 N Ocean Blvd, # 602, Pompano Beach, FL 33062-4644 | 2010-05-12 |
| 1003049230 | Mary Kathleen Russo | Occupational Therapist | 3775 Country Ln, Brownsburg, IN 46112-8375 | 2009-09-04 |
| 1689880619 | Mary Russo | Marriage & Family Therapist | 137 E Hamilton Ave Ste 207, Campbell, CA 95008-0244 | 2007-05-15 |
| 1982970935 | Mary M Russo | Case Manager/Care Coordinator | 420 Magnolia St, Houma, LA 70360-6304 | 2012-03-23 |
| 1225299381 | Mary Elizabeth Russo | Physician Assistant | 540 Union Blvd, West Islip, NY 11795-3105 | 2008-06-21 |
| 1134304967 | Mary Frances Russo | Psychologist | 100 State St, Suite 202, Erie, PA 16507-1454 | 2007-12-28 |
| 1710030234 | Mary Kathleen Russo | Dentist | 804 Highway 71, Sea Girt, NJ 08750-2807 | 2007-01-19 |
| 1205922382 | Mary Russo | Dietitian, Registered | 750 E Adams St, Syracuse, NY 13210-2306 | 2006-10-05 |
| Street Address |
400 W 16TH ST |
| City | PUEBLO |
| State | CO |
| Zip Code | 81003-2745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992700694 | James E Caldwell | Anesthesiology | 400 W 16th St, Pueblo, CO 81003-2745 | 2005-06-17 |
| 1174137806 | Pediatrix Medical Group of Colorado, P.C. | Pediatrics | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-09-01 |
| 1992327217 | Kristina Reavis | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-05-08 |
| 1881214567 | Nathan S Grigg | Student in an Organized Health Care Education/Training Program | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-04-22 |
| 1467083881 | Erik Matthews Wickstrum | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-02-04 |
| 1497385082 | Sean Jastillano | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-22 |
| 1417597287 | Zainab Adeyemo | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-09 |
| 1265071658 | Victoria Louise Farnsworth | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-01-02 |
| 1205479557 | Brandis Courtney Montez | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2019-10-18 |
| 1750923199 | Catholic Health Initiatives Colorado | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1497382303 | Pueblo Family Dentistry Pllc | Dentist | 701 N Grand Avenue, Suite B, Pueblo, CO 81003 | 2020-03-23 |
| 1023654241 | Elmer A. Villalon, Dmd, LLC | Clinic/Center | 1225 North Main Street, #207, Pueblo, CO 81003 | 2019-11-22 |
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1396195665 | Parkview Medical Center | General Acute Care Hospital | 411 W. 14th St, Pueblo, CO 81003 | 2016-06-17 |
| Find all providers in zip 81003 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639496987 | Natalie Marie Mosley | Emergency Medicine | 3676 Parker Blvd., Suite 280, Pueblo, CO 81008-2214 | 2010-04-27 |
| 1073522595 | Teresa Kay Braden | Emergency Medicine | 311 W 14th St, Pueblo, CO 81003-2705 | 2006-08-05 |
| 1124086723 | Michael Todd Duzan | Emergency Medicine | 401 W Northern Ave, Pueblo, CO 81004-3111 | 2006-05-03 |
| 1780664169 | Roger W. Narvaez | Emergency Medicine | 1320 Fortino Blvd, Suite C, Pueblo, CO 81008-2081 | 2006-01-20 |
| 1447233432 | Richard N. Nanes | Emergency Medicine | 4112 Outlook Blvd, Suite 37, Pueblo, CO 81008-1667 | 2005-11-22 |
| 1932735321 | Usacs of Colorado Inc | Emergency Medicine | 1008 Minnequa Ave, Pueblo, CO 81004-3733 | 2020-03-17 |
| 1518499177 | Samuel Grossman | Emergency Medicine | 400 W 16th St, Pueblo, CO 81003-2745 | 2017-03-31 |
| 1750737862 | Trevor Wilson Halle | Emergency Medicine | 1008 Minnequa Ave, Pueblo, CO 81004-3733 | 2016-05-06 |
| 1225491384 | Matthew Rodgers | Emergency Medicine | 400 W 16th St, Pueblo, CO 81003-2745 | 2016-04-05 |
| 1851753974 | Benjamin Honig | Emergency Medicine | 400 W 16th St, Pueblo, CO 81003 | 2016-03-28 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.