Provider Demographics
NPI:1568676369
Name:HARVEY PEDIATRICS. PLLC
Entity Type:Organization
Organization Name:HARVEY PEDIATRICS. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-254-1100
Mailing Address - Street 1:900 S 52ND ST
Mailing Address - Street 2:200
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8637
Mailing Address - Country:US
Mailing Address - Phone:479-254-1100
Mailing Address - Fax:479-254-2997
Practice Address - Street 1:900 S 52ND ST
Practice Address - Street 2:200
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8637
Practice Address - Country:US
Practice Address - Phone:479-254-1100
Practice Address - Fax:479-254-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122915001Medicaid