Provider Demographics
NPI:1275190399
Name:BODAMER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BODAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 FINNEY DR
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-2923
Mailing Address - Country:US
Mailing Address - Phone:540-598-7755
Mailing Address - Fax:540-890-2674
Practice Address - Street 1:1028 FINNEY DR
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-2923
Practice Address - Country:US
Practice Address - Phone:540-598-7755
Practice Address - Fax:540-890-2674
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)