1295946135 NPI number — TIMOTHY P HARRIS, DO

Table of content: (NPI 1295946135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295946135 NPI number — TIMOTHY P HARRIS, DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY P HARRIS, DO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TWIN RIVERS SURGICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295946135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 W 12TH AVE
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66801-2587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-342-6161
Provider Business Mailing Address Fax Number:
620-342-0087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 W 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-6161
Provider Business Practice Location Address Fax Number:
620-342-0087
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
620-342-6161

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  0521008 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100231930A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020015054 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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