1720202583 NPI number — RICHARD G. HARRIS, MD, LTD

Table of content: (NPI 1720202583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720202583 NPI number — RICHARD G. HARRIS, MD, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD G. HARRIS, MD, LTD
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:
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:
1720202583
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89435-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-352-3535
Provider Business Mailing Address Fax Number:
775-352-3530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2385 E PRATER WAY
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89434-9629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-352-3535
Provider Business Practice Location Address Fax Number:
775-352-3530
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
775-352-3535

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  7275 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050063835 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 002016718 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com