=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790058154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRISON HEALTH, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2012
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 781 ROZA DR
-----------------------------------------------------
City | ZILLAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98953-9351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-658-0310
-----------------------------------------------------
Fax | 877-334-1891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 781 ROZA DR
-----------------------------------------------------
City | ZILLAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98953-9351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-658-0310
-----------------------------------------------------
Fax | 877-334-1891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RENEE WOODS HARRISON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 888-658-0310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 603175263
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------