Provider Demographics
NPI:1083089726
Name:MEDICAL COMMAND CLINICAL PRACTICE OF PENNSYLVANIA PC
Entity Type:Organization
Organization Name:MEDICAL COMMAND CLINICAL PRACTICE OF PENNSYLVANIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-754-8700
Mailing Address - Street 1:PO BOX 785186
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-5186
Mailing Address - Country:US
Mailing Address - Phone:214-712-2815
Mailing Address - Fax:888-491-7218
Practice Address - Street 1:13737 NOEL RD
Practice Address - Street 2:SUITE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1331
Practice Address - Country:US
Practice Address - Phone:214-712-2815
Practice Address - Fax:888-491-7218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty