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DR. JACK HAVDALA M.D. NPI 1477558955


NPI Information

NPI: 1477558955
Provider Name: DR. JACK HAVDALA, M.D.
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

PECOS Registration: Yes

Address:
201 E OAK AVE
JONESBORO, AR
ZIP 72401
Phone: (870) 935-6729
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DR. Jack Havdala, M.D. is a vascular surgery surgery in Jonesboro, AR with 34 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. Jack Havdala, M.D. NPI is 1477558955. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: R FRANKLIN UNIVERSITY OF MED & SCI/CHICAGO MEDICAL SCHOOL
Graduation Year:1990

The provider's business location address is:

201 E OAK AVE
JONESBORO, AR
ZIP 72401
Phone: (870) 935-6729
Fax: (870) 268-4408

The NPI 1477558955 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Replacement of aortic valve with prosthetic valve, accessed through the skin (HCPCS:33361)
  • Heart artery bypass to repair one artery (HCPCS:33533)
  • Harvest of veins for coronary artery bypass procedure using an endoscope (HCPCS:33508)
  • Routine electrocardiogram (ekg) using at least 12 leads with interpretation and report (HCPCS:93010)

The enumeration date for this NPI number is 6/20/2005 and was last updated on 3/7/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12086S0129XSurgeryVascular SurgeryE3961ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1E3961OTHERARKANSASSTATE LICENSE
232638100MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.