Provider Demographics
NPI:1679687412
Name:HARRIS HEALTHCARE LLC
Entity Type:Organization
Organization Name:HARRIS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-721-4828
Mailing Address - Street 1:7348 W. 21ST ST N.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1765
Mailing Address - Country:US
Mailing Address - Phone:316-721-4828
Mailing Address - Fax:316-721-4844
Practice Address - Street 1:7348 W. 21ST ST N
Practice Address - Street 2:SUITE 107
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1765
Practice Address - Country:US
Practice Address - Phone:316-721-4828
Practice Address - Fax:316-721-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160985OtherBCBS
KSDA3337OtherRAILROAD MEDICARE
KS200001300AMedicaid
KS160985OtherBCBS
KSDA3337OtherRAILROAD MEDICARE