Provider Demographics
NPI:1588859862
Name:JAMES H SIMONDS DPM PC
Entity Type:Organization
Organization Name:JAMES H SIMONDS DPM PC
Other - Org Name:SIMONDS FOOT & ANKLE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:269-381-9060
Mailing Address - Street 1:126 E KILGORE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-0598
Mailing Address - Country:US
Mailing Address - Phone:269-381-9060
Mailing Address - Fax:269-381-1336
Practice Address - Street 1:126 E KILGORE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-0598
Practice Address - Country:US
Practice Address - Phone:269-381-9060
Practice Address - Fax:269-381-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC96248OtherBLUE CROSS BLUE SHIELD
MIDN0165OtherRAILROAD MEDICARE PART B
MIOC962487482OtherMEDICARE GROUP
MI001178OtherSTATE LICENSE
MI001178OtherSTATE LICENSE
MIOC962487482OtherMEDICARE GROUP
MIOC96248OtherBLUE CROSS BLUE SHIELD