MEDICARE: J H HARVEY CO LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

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	1142164	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1669580031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J H HARVEY CO LLC

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	MS3000
City	:	PORTLAND
State	:	ME
Zip	:	04104-5005
Country	:	US
Telephone Number	:	207-885-7454
Fax Number	:	207-396-2028

Provider Business Practice Location Address
First Line	:	2111 BEMISS RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1940
Country	:	US
Telephone Number	:	229-244-1865
Fax Number	:	229-241-0398

Authorized Official
Title or Position	:	PHARMACY INSURANCE SPECIALIST
Name	:	COURTNEY FAIRBANKS
Credential	:
Telephone Number	:	207-885-7454

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	03/11/2011

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Directions to “J H HARVEY CO LLC ” Practice Location

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