Healthcare Provider Details

I. General information

NPI: 1366920746
Provider Name (Legal Business Name): HARRISON FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18119 SUSSEX HWY UNIT 1
BRIDGEVILLE DE
19933-4095
US

IV. Provider business mailing address

16812 OAK RD
BRIDGEVILLE DE
19933-3980
US

V. Phone/Fax

Practice location:
  • Phone: 302-228-5128
  • Fax:
Mailing address:
  • Phone: 302-228-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES ROBERT HARRISON
Title or Position: MANAGER
Credential:
Phone: 302-462-1365