Provider Demographics
NPI:1477781680
Name:JERRY L HARVEY, DO, PA
Entity Type:Organization
Organization Name:JERRY L HARVEY, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:501-605-9355
Mailing Address - Street 1:15361 HIGHWAY 5
Mailing Address - Street 2:SUITE E
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-5128
Mailing Address - Country:US
Mailing Address - Phone:501-605-9355
Mailing Address - Fax:
Practice Address - Street 1:15361 HIGHWAY 5
Practice Address - Street 2:SUITE E
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-5128
Practice Address - Country:US
Practice Address - Phone:501-605-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125608003Medicaid
AR5J444OtherMEDICARE ID-TYPE UNSPECIFIED
AR5J444OtherMEDICARE ID-TYPE UNSPECIFIED