MEDICARE: HARVEST HEALTH SERVICES LLC

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	261QP2300X	Primary Care Clinic/Center	NP 06040	OH

General Provider Information

NPI Number	:	1386811024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEST HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 329
Second Line	:
City	:	COMMERCIAL POINT
State	:	OH
Zip	:	43116-0329
Country	:	US
Telephone Number	:	614-877-9175
Fax Number	:	614-877-1601

Provider Business Practice Location Address
First Line	:	5 MAIN ST
Second Line	:
City	:	COMMERCIAL POINT
State	:	OH
Zip	:	43116-0329
Country	:	US
Telephone Number	:	614-877-9175
Fax Number	:	614-877-1601

Authorized Official
Title or Position	:	OWNER
Name	:	DONNA M SPENCER
Credential	:	CNP
Telephone Number	:	614-877-9175

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	04/15/2015

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