Healthcare Provider Details

I. General information

NPI: 1154464451
Provider Name (Legal Business Name): HARVEY MEDCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 WESTBANK EXPY SUITE 1B
HARVEY LA
70058-2600
US

IV. Provider business mailing address

3709 WESTBANK EXPY SUITE 1B
HARVEY LA
70058-2600
US

V. Phone/Fax

Practice location:
  • Phone: 504-348-2310
  • Fax: 504-348-1942
Mailing address:
  • Phone: 504-348-2310
  • Fax: 504-348-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRAM VU JACOBS
Title or Position: ASSISTANT
Credential:
Phone: 504-348-2310