Provider Demographics
NPI:1538314745
Name:HARVEY J. FEATHERSTONE, MD, PC
Entity Type:Organization
Organization Name:HARVEY J. FEATHERSTONE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:575-354-1515
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:CAPITAN
Mailing Address - State:NM
Mailing Address - Zip Code:88316-0667
Mailing Address - Country:US
Mailing Address - Phone:575-354-1515
Mailing Address - Fax:575-354-1815
Practice Address - Street 1:517 HIGHWAY 380
Practice Address - Street 2:CHRIST COMMUNITY CHURCH
Practice Address - City:CAPITAN
Practice Address - State:NM
Practice Address - Zip Code:88316-0667
Practice Address - Country:US
Practice Address - Phone:575-354-1515
Practice Address - Fax:575-354-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-45261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA04461Medicare UPIN