Tia Covington Harris, AA-C | |
225 S Executive Dr, Brookfield, WI 53005-4257 | |
(262) 787-6758 | |
Not Available |
Full Name | Tia Covington Harris |
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Gender | Female |
Speciality | Anesthesiologist Assistant |
Location | 225 S Executive Dr, Brookfield, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225410442 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
367H00000X | Anesthesiologist Assistant | AA393 (Florida) | Primary |
Entity Name | Baycare Medical Group, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1043269871 PECOS PAC ID: 6406753623 Enrollment ID: O20031216000718 |
Entity Name | American Anesthesiology Services Of Florida Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1508318387 PECOS PAC ID: 1850674540 Enrollment ID: O20170202001989 |
Mailing Address | Practice Location Address |
---|---|
Tia Covington Harris, AA-C 758 14th Ave S, Saint Petersburg, FL 33701-5314 Ph: (727) 470-8377 | Tia Covington Harris, AA-C 225 S Executive Dr, Brookfield, WI 53005-4257 Ph: (262) 787-6758 |
Dylan Bray, AA Anesthesiologist Assistant Medicare: Medicare Enrolled Practice Location: 225 S Executive Dr, Brookfield, WI 53005 Phone: 608-770-0908 | |
Mr. Justin Matthew Kitson, CAA Anesthesiologist Assistant Medicare: Medicare Enrolled Practice Location: 225 S Executive Dr, Brookfield, WI 53005 Phone: 262-787-6758 |