Provider Demographics
NPI:1942265053
Name:JAMES, THOMAS III (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JAMES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-772-8189
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014285E207R00000X, 208000000X, 207R00000X
KY16982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B06330Medicare UPIN
049508OtherSIHO - NCMA
IN200509000Medicaid
KY1361937Medicare PIN
KY000028412KOtherHUMANA / NCMA
KY0254554OtherCIGNA / NCMA
KY2447427000OtherPAD - NCMA
B06330Medicare UPIN
KY64097322Medicaid
KYP00181546OtherRAILROAD MEDICARE
KY50006146OtherPASSPORT - NCMA