Provider Demographics
NPI:1306026851
Name:JAMES F RICHARDSON MD PA
Entity Type:Organization
Organization Name:JAMES F RICHARDSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-967-3920
Mailing Address - Street 1:304 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2606
Mailing Address - Country:US
Mailing Address - Phone:864-967-3920
Mailing Address - Fax:864-962-1486
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2606
Practice Address - Country:US
Practice Address - Phone:864-967-3920
Practice Address - Fax:864-962-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4473207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC0904Medicaid
SCPC0904Medicaid
SC2673Medicare PIN