Provider Demographics
NPI:1255224861
Name:HARRIS, WILLIAM H SR
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:HARRIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5463 YALE LN
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1642
Mailing Address - Country:US
Mailing Address - Phone:708-701-3227
Mailing Address - Fax:708-606-8037
Practice Address - Street 1:6544 S EBERHART AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3206
Practice Address - Country:US
Practice Address - Phone:708-701-3227
Practice Address - Fax:708-606-8037
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILDW46643343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)