Healthcare Provider Details

I. General information

NPI: 1740527894
Provider Name (Legal Business Name): HARRIS ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 DIRKSHIRE CT
MARS PA
16046-2222
US

IV. Provider business mailing address

302 DIRKSHIRE CT
MARS PA
16046-2222
US

V. Phone/Fax

Practice location:
  • Phone: 412-979-6893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberRN-502790L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STACY HARRIS
Title or Position: MANAGER
Credential: CRNA
Phone: 412-979-6893