MEDICARE: RICHARD HARBISON MDPC

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	207R00000X	Internal Medicine Physician	CO34303	CO

General Provider Information

NPI Number	:	1669656658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD HARBISON MDPC

Provider Business Mailing Address
First Line	:	PO BOX 15497
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80935-5497
Country	:	US
Telephone Number	:	719-473-4030
Fax Number	:	719-590-8636

Provider Business Practice Location Address
First Line	:	830 TENDERFOOT HILL RD
Second Line	:	SUITE 150
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-2314
Country	:	US
Telephone Number	:	719-590-9292
Fax Number	:	719-590-8636

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. GRACE HARBISON
Credential	:
Telephone Number	:	719-590-9292

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	07/28/2010

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