MEDICARE: ROBERT HARRIS

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	343900000X	Non-emergency Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)		OH

General Provider Information

NPI Number	:	1578393518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HARRIS

Provider Business Mailing Address
First Line	:	PO BOX 140542
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-0542
Country	:	US
Telephone Number	:	734-772-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 CHELTENHAM RD APT 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1824
Country	:	US
Telephone Number	:	734-772-8751
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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