Provider Demographics
NPI:1215518113
Name:HARKNESS MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:HARKNESS MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARKNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-410-5472
Mailing Address - Street 1:412 BLACK HILLS LN SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8142
Mailing Address - Country:US
Mailing Address - Phone:360-567-6064
Mailing Address - Fax:
Practice Address - Street 1:412 BLACK HILLS LN SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8142
Practice Address - Country:US
Practice Address - Phone:360-567-6064
Practice Address - Fax:833-731-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty