Harry Taylor Harness, DO
Individual provider Active NPI Family Medicine Physician · Pilot Knob, MO
NPI 1992819627 · NPPES record last updated Mar 29, 2017
Key facts
- NPI
- 1992819627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R9682 (MO)
- Practice address
- 315 West Mulberry Street
Pilot Knob, MO 63663 - Phone
- (573) 546-0602
- Fax
- (573) 546-0624
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100201000631 | MO | Practitioner - Family Practice |
0244216265 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R9682 | MO | MD | Family Medicine Physician |
| DO0000000858 | TN | MD | Family Medicine Physician |
| 235 | SC | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Springs Medical Association | Current | Accepting new patients | |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 235 | SC | |
| Family Medicine Physician | 207Q00000X | R9682 | MO | Yes |
| Family Medicine Physician | 207Q00000X | DO0000000858 | TN |
Addresses
Primary practice location
315 West Mulberry Street
Pilot Knob, MO 63663
Mailing address
1500 N Westwood Blvd
P.O. Box 327
Poplar Bluff, MO 63901-3318
Phone (573) 778-4760
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002357 | Medicaid | SC |
Other providers in Pilot Knob, MO
- Big Springs Medical Association
- Jill Bleything
- Boonyasai & Boonyasai, M.D.P. C.
- Boonfu Boonyasai
- Vatana C. Boonyasai
- Jami Hedrick
- Iron County Ambulance District
- Iron County Hospital District
- Iron County Hospital District
- Chelsea L Isgrig
All providers in Pilot Knob, MO · Family Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.