=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215040258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA J HARRISON M D P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 SIOUX VALLEY DR
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51012-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-225-6441
-----------------------------------------------------
Fax | 712-225-3333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 SIOUX VALLEY DR PO BOX 519
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51012-1205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-225-6441
-----------------------------------------------------
Fax | 712-225-3333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. PATRICIA J HARRISON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 712-225-6441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------