1982735346 NPI number — STEPHEN R. HARRIS, M.D. INC

Table of content: (NPI 1982735346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982735346 NPI number — STEPHEN R. HARRIS, M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN R. HARRIS, M.D. INC
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:
WELLNESS WORKS
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:
1982735346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7300 REMCON CIR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-532-3600
Provider Business Mailing Address Fax Number:
915-532-8999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 REMCON CIR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-3600
Provider Business Practice Location Address Fax Number:
915-532-8999
Provider Enumeration Date:
03/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-532-3600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 171517901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C57S . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".