Provider Demographics
NPI:1457489700
Name:ANIL HARRISON M.D. PSC
Entity Type:Organization
Organization Name:ANIL HARRISON M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-625-5242
Mailing Address - Street 1:1054 CENTER DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3851
Mailing Address - Country:US
Mailing Address - Phone:859-625-5242
Mailing Address - Fax:859-625-5279
Practice Address - Street 1:1054 CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3851
Practice Address - Country:US
Practice Address - Phone:859-625-5242
Practice Address - Fax:859-625-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32105261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCK2254OtherRAIL ROAD MEDICARE
KY1457489700OtherNPI
KY1457489700OtherNPI