Provider Demographics
NPI:1356352363
Name:HARRIS HEALTHCARE GROUP, PLLC
Entity type:Organization
Organization Name:HARRIS HEALTHCARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-574-9035
Mailing Address - Street 1:8323 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 561
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-665-3645
Mailing Address - Fax:281-888-3675
Practice Address - Street 1:8323 SOUTHWEST FWY
Practice Address - Street 2:SUITE 561
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1615
Practice Address - Country:US
Practice Address - Phone:713-574-9035
Practice Address - Fax:281-888-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351311041C0700X
TXL5000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356352363Medicare PIN
TX00X255Medicare PIN
TXH73344Medicare UPIN
TX1073524005Medicare PIN
TX1336246487Medicare PIN