Provider Demographics
NPI:1043497258
Name:HARVEY G VAN DELL, MD, PA, PLLC
Entity Type:Organization
Organization Name:HARVEY G VAN DELL, MD, PA, PLLC
Other - Org Name:GUY VAN DELL, MD, PA ; FLOWER MOUND WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:GUYTON
Authorized Official - Last Name:VAN DELL
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:972-899-9787
Mailing Address - Street 1:2980 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4845
Mailing Address - Country:US
Mailing Address - Phone:972-899-9787
Mailing Address - Fax:972-899-9786
Practice Address - Street 1:2980 LONG PRAIRIE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4845
Practice Address - Country:US
Practice Address - Phone:972-899-9787
Practice Address - Fax:972-899-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8697207VX0000X
TX536369367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151884703Medicaid
TX45D1042013OtherCLIA
TX0065MTOtherBCBS
TX180279501OtherMEDICAID GROUP
TX10007551OtherAMERIGROUP
TX7215354OtherAETNA
TX7215354OtherAETNA
TX151884703Medicaid