Provider Demographics
NPI:1750439196
Name:HARRIS CLINIC LLC
Entity type:Organization
Organization Name:HARRIS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-356-0555
Mailing Address - Street 1:431 CROSSROADS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4865
Mailing Address - Country:US
Mailing Address - Phone:318-272-4276
Mailing Address - Fax:318-797-3650
Practice Address - Street 1:415 BIENVILLE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5737
Practice Address - Country:US
Practice Address - Phone:318-356-0555
Practice Address - Fax:318-356-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D829Medicare PIN