Provider Demographics
NPI:1518998541
Name:WILLIAM A HARRISON, MD, PC
Entity Type:Organization
Organization Name:WILLIAM A HARRISON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-565-5512
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1226
Mailing Address - Country:US
Mailing Address - Phone:505-888-0443
Mailing Address - Fax:505-205-1057
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1226
Practice Address - Country:US
Practice Address - Phone:505-888-0443
Practice Address - Fax:505-205-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM79174207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP59294675OtherMULTI-PLAN PROV NUMBER
NM00011841Medicaid
NMNM001175OtherBCBS PROV NUMBER
NM843OtherLOVELACE HEALTH PLAN PROV
NM00011841Medicaid