MEDICARE: HARRIS MEDICAL TRANSPORT, LLC

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	343900000X	Non-emergency Medical Transport (VAN)	256155	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720393499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS MEDICAL TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	2512 OSCEOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1136
Country	:	US
Telephone Number	:	614-261-6500
Fax Number	:	614-261-6501

Provider Business Practice Location Address
First Line	:	2512 OSCEOLA AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1136
Country	:	US
Telephone Number	:	614-261-6500
Fax Number	:	614-261-6501

Authorized Official
Title or Position	:	OWNER
Name	:	MISS TISHA HARRIS
Credential	:
Telephone Number	:	614-261-6500

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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