Provider Demographics
NPI:1205018553
Name:PETER M HARVEY
Entity Type:Organization
Organization Name:PETER M HARVEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:940-723-1054
Mailing Address - Street 1:1612 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4307
Mailing Address - Country:US
Mailing Address - Phone:940-723-1054
Mailing Address - Fax:940-723-4646
Practice Address - Street 1:1612 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4307
Practice Address - Country:US
Practice Address - Phone:940-723-1054
Practice Address - Fax:940-723-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0346332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F621OtherBLUE CROSS BLUE SHIELD
TX00F621OtherTAX ID NUMBER
TX346OtherSTATE LICENCE NUMBER
TX346OtherSTATE LICENCE NUMBER
TXT13729Medicare UPIN
TX00F621OtherTAX ID NUMBER