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General NPI Number Information
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NPI Number | 1023885050
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Entity Type | Organization
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Legal Business Name | HARRIS FAMILY CLINIC LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 403 E WASHINGTON ST
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City | HOUSTON
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State | MS
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Zip | 38851-2318
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Country | US
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Telephone | 662-792-6601
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Fax | 406-315-7338
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Provider Business Mailing Address
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Address Line | 403 E WASHINGTON ST
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City | HOUSTON
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State | MS
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Zip | 38851-2318
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Country | US
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Telephone | 662-792-6601
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ARETHA RENEE HARRIS
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Credential | FNP-C
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Telephone | 662-631-4316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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