Provider Demographics
NPI:1164401725
Name:JAMES A M SALES MD SC
Entity Type:Organization
Organization Name:JAMES A M SALES MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AM
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-786-0600
Mailing Address - Street 1:2508 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5419
Mailing Address - Country:US
Mailing Address - Phone:309-786-0600
Mailing Address - Fax:309-786-8352
Practice Address - Street 1:2508 25TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5419
Practice Address - Country:US
Practice Address - Phone:309-786-0600
Practice Address - Fax:309-786-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0360972672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097267Medicaid
G85709Medicare UPIN
IL209597Medicare PIN
DN1439Medicare PIN