Provider Demographics
NPI:1326207184
Name:PITTS, JAMES D (PAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:PITTS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEERPATH
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-9427
Mailing Address - Country:US
Mailing Address - Phone:217-345-2727
Mailing Address - Fax:
Practice Address - Street 1:100 DEERPATH
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-9427
Practice Address - Country:US
Practice Address - Phone:217-345-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85000501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85000501OtherSTATE OF ILLINOIS LICENSE