Healthcare Provider Details

I. General information

NPI: 1770519985
Provider Name (Legal Business Name): HARRISON FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FEDERAL DR NW SUITE 200
CORYDON IN
47112-3070
US

IV. Provider business mailing address

PO BOX 455
CORYDON IN
47112-0455
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4155
  • Fax: 812-738-6104
Mailing address:
  • Phone: 812-738-4155
  • Fax: 812-738-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. GEORGE F ESTILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 812-738-4155