Provider Demographics
NPI:1053045773
Name:SCOTT HARRIS LLC
Entity Type:Organization
Organization Name:SCOTT HARRIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-396-0222
Mailing Address - Street 1:1551 E TRINITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3802
Mailing Address - Country:US
Mailing Address - Phone:334-396-0222
Mailing Address - Fax:334-396-0227
Practice Address - Street 1:1551 E TRINITY BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3802
Practice Address - Country:US
Practice Address - Phone:334-396-0222
Practice Address - Fax:334-396-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental