Provider Demographics
NPI:1245396936
Name:JAMES H ADAMS JR PSC
Entity Type:Organization
Organization Name:JAMES H ADAMS JR PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-247-2764
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-0031
Mailing Address - Country:US
Mailing Address - Phone:270-247-2764
Mailing Address - Fax:270-247-0244
Practice Address - Street 1:329 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2211
Practice Address - Country:US
Practice Address - Phone:270-247-2764
Practice Address - Fax:270-247-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60051075Medicaid