Provider Demographics
NPI:1114255262
Name:JAMES N. PACE
Entity Type:Organization
Organization Name:JAMES N. PACE
Other - Org Name:WYOMISSING PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-376-5649
Mailing Address - Street 1:916 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3017
Mailing Address - Country:US
Mailing Address - Phone:610-376-5649
Mailing Address - Fax:610-376-4194
Practice Address - Street 1:916 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3017
Practice Address - Country:US
Practice Address - Phone:610-376-5649
Practice Address - Fax:610-376-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002934L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4511300001Medicare NSC