Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lakeshore Pediatrics of Russellville

Organization Pediatrics Physician · NPI 1194907394

Lakeshore Pediatrics of Russellville is a Pediatrics Physician in Russellville, Alabama. Licensed in Alabama. Registered with an NPI since 2007.

Licensed in
AL
In the registry since
2007
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Practice location Address checks out

603 Gandy St NE
Russellville, AL 35653-1911
Phone: (256) 331-5055
Fax: (256) 383-7293
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 2006323 (AL)

Record details

NPI number1194907394
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Agustin Rivas — Owner · (256) 386-4151
NPI enumeratedNovember 29, 2007
Last updated in NPPESNovember 29, 2007
Mailing address1120 S Jackson Hwy, Suite 304, Sheffield, AL 35660-5777

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