Provider Demographics
NPI:1245263276
Name:HARRISON MEDICAL INC.
Entity type:Organization
Organization Name:HARRISON MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC-TREAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-589-9325
Mailing Address - Street 1:721 SOUTH PRESTON ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:502-589-9325
Mailing Address - Fax:502-585-5202
Practice Address - Street 1:721 SOUTH PRESTON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:502-589-9325
Practice Address - Fax:502-585-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000070036OtherANTHEM
KY2432836000OtherPASSPORT ADVANTAGE
KY90210568Medicaid
KY1050370OtherPASSPORT
000000070036OtherANTHEM
KY0140870001Medicare ID - Type Unspecified