Provider Demographics
NPI:1225026966
Name:HARVEY, DANA S (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:S
Last Name:HARVEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59755-0335
Mailing Address - Country:US
Mailing Address - Phone:406-843-5463
Mailing Address - Fax:
Practice Address - Street 1:210 E CROFOOT
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MT
Practice Address - Zip Code:59749
Practice Address - Country:US
Practice Address - Phone:406-842-5056
Practice Address - Fax:406-842-5057
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
95733OtherBCBS
MT4303247Medicaid
000071710Medicare ID - Type Unspecified
95733OtherBCBS