Provider Demographics
NPI:1952313942
Name:HARRIS, BILL H (MD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:H
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9302
Mailing Address - Country:US
Mailing Address - Phone:304-647-4411
Mailing Address - Fax:
Practice Address - Street 1:1322 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8016
Practice Address - Country:US
Practice Address - Phone:304-793-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17915207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051882OtherANTHEM
KY64179153Medicaid
KYP00419636OtherRAILROAD MEDICARE
KYC64475Medicare UPIN
KYP00364476Medicare PIN
KY3403728Medicare PIN
KY64179153Medicaid
KY0527609Medicare ID - Type Unspecified
KY0527409Medicare ID - Type Unspecified
KY3403728Medicare PIN
KYP00419636OtherRAILROAD MEDICARE
KY000000051882OtherANTHEM
KY0573114Medicare ID - Type Unspecified