MEDICARE: OFELIA HARRISON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	04-29838	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103966	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1366480691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OFELIA HARRISON MD

Provider Business Mailing Address
First Line	:	9313 E 34TH ST N
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-2621
Country	:	US
Telephone Number	:	316-685-6091
Fax Number	:

Provider Business Practice Location Address
First Line	:	6611 E CENTRAL AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1937
Country	:	US
Telephone Number	:	316-685-6091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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