MEDICARE: TAMMY L 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	253Z00000X	In Home Supportive Care Agency	25-018569-1	IN

General Provider Information

NPI Number	:	1821800327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY L HARRIS

Provider Business Mailing Address
First Line	:	195 N SHORTRIDGE RD STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-8909
Country	:	US
Telephone Number	:	317-714-2638
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 N SHORTRIDGE RD STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-8909
Country	:	US
Telephone Number	:	317-714-2638
Fax Number	:

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

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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