| Harrison Family Medicine | |
|
1100 Southgate Ste 2 Pendleton OR 97801-3971 | |
| (541) 215-1564 | |
| (541) 215-1567 |
| Full Name | Harrison Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1100 Southgate Ste 2, Pendleton, Oregon |
| Authorized Official Name and Position | Russell B Harrison (OWNER/OPERATOR) |
| Authorized Official Contact | 5412151564 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harrison Family Medicine Po Box 1125 Pendleton OR 97801-0100 Ph: (541) 215-1564 | Harrison Family Medicine 1100 Southgate Ste 2 Pendleton OR 97801-3971 Ph: (541) 215-1564 |
| NPI Number | 1154764405 |
|---|---|
| Provider Enumeration Date | 04/16/2013 |
| Last Update Date | 01/27/2021 |
| Medicare PECOS PAC ID | 1850530841 |
|---|---|
| Medicare Enrollment ID | O20130624000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154764405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD29141 (Oregon) | Primary |
| Provider Name | Russell B Harrison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164409173 PECOS PAC ID: 7315096047 Enrollment ID: I20090617000600 |
| Provider Name | Andrea Yolanda Carrasco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427023621 PECOS PAC ID: 9032242870 Enrollment ID: I20190719001285 |
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