Provider Demographics
NPI:1073920294
Name:SPOOR, JIM MICHAEL (EMT)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:MICHAEL
Last Name:SPOOR
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:MICHAEL
Other - Last Name:SPOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EMT
Mailing Address - Street 1:18 CLIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-2602
Mailing Address - Country:US
Mailing Address - Phone:845-210-1056
Mailing Address - Fax:
Practice Address - Street 1:18 CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-2602
Practice Address - Country:US
Practice Address - Phone:845-210-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138125146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY138152OtherNEW YORK STATE