MEDICARE: HARVEY G VAN DELL, MD, PA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	536369	TX
2	207VX0000X	Obstetrics Physician	K8697	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45D1042013	OTHER	TX	CLIA
3	0065MT	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	10007551	OTHER	TX	AMERIGROUP
6	7215354	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1043497258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEY G VAN DELL, MD, PA, PLLC

Provider Business Mailing Address
First Line	:	2980 LONG PRAIRIE RD
Second Line	:	SUITE E
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4845
Country	:	US
Telephone Number	:	972-899-9787
Fax Number	:	972-899-9786

Provider Business Practice Location Address
First Line	:	2980 LONG PRAIRIE RD
Second Line	:	SUITE E
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4845
Country	:	US
Telephone Number	:	972-899-9787
Fax Number	:	972-899-9786

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. HARVEY GUYTON VAN DELL IV
Credential	:	M.D.
Telephone Number	:	972-899-9787

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	04/30/2013

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