Healthcare Provider Details

I. General information

NPI: 1538314745
Provider Name (Legal Business Name): HARVEY J. FEATHERSTONE, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HIGHWAY 380 CHRIST COMMUNITY CHURCH
CAPITAN NM
88316-0667
US

IV. Provider business mailing address

PO BOX 667
CAPITAN NM
88316-0667
US

V. Phone/Fax

Practice location:
  • Phone: 575-354-1515
  • Fax: 575-354-1815
Mailing address:
  • Phone: 575-354-1515
  • Fax: 575-354-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number91-45
License Number StateNM

VIII. Authorized Official

Name: DR. HARVEY J. FEATHERSTONE
Title or Position: PRESIDENT
Credential: M.D., M.P.H.
Phone: 575-354-1515