Provider Demographics
NPI:1487654224
Name:HARVEY, HAROLD B (C-PA)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:B
Last Name:HARVEY
Suffix:
Gender:M
Credentials:C-PA
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Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL HARRISON PEEPLES HEALTHCARE CENTER
Practice Address - Street 2:1000 PINE STREET WEST
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-0969
Practice Address - Country:US
Practice Address - Phone:803-943-5228
Practice Address - Fax:844-295-9899
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2019-07-24
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Provider Licenses
StateLicense IDTaxonomies
SC204363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0001PAMedicaid
SCQM0236Medicaid
SC570669239OtherFED TIN
SCGP0365Medicaid
SC423820Medicare Oscar/Certification
SCR82972Medicare UPIN
SC4004Medicare PIN