Basic Information
| Provider Information | |||||||||
| NPI: | 1932103785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARSTON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 90039 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421029039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707968800 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 S COURT ST | ||||||||
| Address2: | |||||||||
| City: | SCOTTSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421641263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702394000 | ||||||||
| FaxNumber: | 2707969328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 24447 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 700005564 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000044740 | 01 | KY | ANTHEM | OTHER | 50006915 | 01 | KY | PASSPORT | OTHER | 64244478 | 05 | KY | MEDICAID |