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General NPI Number Information
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NPI Number | 1528722675
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Entity Type | Individual
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Provider Name | JIMMY LEE HARRIS
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Gender | Male
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 654 SPENCER RD APT 3E
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City | ITHACA
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State | NY
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Zip | 14850-5127
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Country | US
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Telephone | 929-810-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 622 W 137TH ST APT 24
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City | NEW YORK
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State | NY
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Zip | 10031-8042
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Country | US
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Telephone | 929-810-7610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 794609483
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License Number State | NY
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