1467724294 NPI number — HARVEY NORRIS

Table of content: HARVEY NORRIS (NPI 1467724294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467724294 NPI number — HARVEY NORRIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
HARVEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1467724294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6606 MONROE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71405-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-508-8104
Provider Business Mailing Address Fax Number:
866-399-5815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 SHREVEPORT HWY
Provider Second Line Business Practice Location Address:
BUILDING 3, ROOM 115, SERVICE 122
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-375-8387
Provider Business Practice Location Address Fax Number:
866-399-5915
Provider Enumeration Date:
02/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW8113 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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