Provider Demographics
NPI:1245233915
Name:LOOMIS, JAMES F (MSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:LOOMIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3923
Mailing Address - Country:US
Mailing Address - Phone:269-327-7472
Mailing Address - Fax:269-327-7472
Practice Address - Street 1:1398 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3923
Practice Address - Country:US
Practice Address - Phone:269-327-7472
Practice Address - Fax:269-327-7472
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010020361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M20710Medicare ID - Type Unspecified