Provider Demographics
NPI:1811550601
Name:J. TIMOTHY AMES, MD PC
Entity Type:Organization
Organization Name:J. TIMOTHY AMES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:AMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-767-4858
Mailing Address - Street 1:751 E PORTER AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9111
Mailing Address - Country:US
Mailing Address - Phone:219-767-4858
Mailing Address - Fax:219-413-9682
Practice Address - Street 1:751 E PORTER AVE STE 5
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-9111
Practice Address - Country:US
Practice Address - Phone:219-767-4858
Practice Address - Fax:219-413-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200057750AMedicaid