Provider Demographics
NPI:1518996123
Name:MCVAY, RICH
Entity Type:Individual
Prefix:
First Name:RICH
Middle Name:
Last Name:MCVAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3629
Mailing Address - Country:US
Mailing Address - Phone:479-524-4141
Mailing Address - Fax:479-549-2576
Practice Address - Street 1:205 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3629
Practice Address - Country:US
Practice Address - Phone:479-524-4141
Practice Address - Fax:479-549-2576
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114982701Medicaid
OK100783980AMedicaid
MO1518996123Medicaid
AR59238G180Medicare PIN
AR114982701Medicaid