Provider Demographics
NPI:1578584579
Name:HARVEST MEDICAL CLINIC
Entity Type:Organization
Organization Name:HARVEST MEDICAL CLINIC
Other - Org Name:HENRY E. TOMLINSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-836-5036
Mailing Address - Street 1:1856 E. FLORENCE BLVD.
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-836-5036
Mailing Address - Fax:520-836-9326
Practice Address - Street 1:1856 E. FLORENCE BLVD.
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-836-5036
Practice Address - Fax:520-836-9326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ845042AZMedicaid
AZ269234Medicare PIN