MEDICARE: TYRONE K HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043918360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE K HARRIS

Provider Business Mailing Address
First Line	:	12074 ROCKWELL ROAD
Second Line	:
City	:	MOUNT STERLING
State	:	OH
Zip	:	43143
Country	:	US
Telephone Number	:	740-296-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 W MAIN ST APT D
Second Line	:
City	:	MOUNT STERLING
State	:	OH
Zip	:	43143-1264
Country	:	US
Telephone Number	:	740-296-0095
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	02/16/2023

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