Basic Information
| Provider Information | |||||||||
| NPI: | 1356392955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEITH A. HARVEY MD; PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 HIGH ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467332361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607242145 | ||||||||
| FaxNumber: | 2607283858 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 HIGH ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | DECATUR | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607242145 | ||||||||
| FaxNumber: | 2607283858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | STRICKLER | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | INSURANCE ADM | ||||||||
| AuthorizedOfficialTelephone: | 2607242145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01046376A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200804690A | 05 | IN | MEDICAID |