Provider Demographics
NPI:1104863950
Name:STORY, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:STORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2248
Mailing Address - Country:US
Mailing Address - Phone:864-583-8647
Mailing Address - Fax:864-542-2227
Practice Address - Street 1:1083 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2248
Practice Address - Country:US
Practice Address - Phone:864-583-8647
Practice Address - Fax:864-542-2227
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10272207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102720Medicaid
31368OtherMEDCOST PIN
4276018OtherAETNA PIN
NC890674CMedicaid
110098680Medicare ID - Type UnspecifiedMEDICARE RAILROAD
NC890674CMedicaid
31368OtherMEDCOST PIN
D993758688Medicare PIN
SC102720Medicaid