1649221508 NPI number — DR. STEPHEN D HARRISON M.D.

Table of content: CHRISTINA ELAINE ADAMS (NPI 1811129877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649221508 NPI number — DR. STEPHEN D HARRISON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
STEPHEN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1649221508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 13TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52732-5067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-243-2511
Provider Business Mailing Address Fax Number:
563-243-0817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61252-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-589-2121
Provider Business Practice Location Address Fax Number:
815-589-4468
Provider Enumeration Date:
05/15/2006

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: 207Q00000X , with the licence number:  24271 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0219477 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20317 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 018854 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18999 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27100 . This is a "IOWA HEALTH SOLUTIOS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29840094 . This is a "ILLINOIS BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036070350 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: IA0118 . This is a "JOHN DEERE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09822109 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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