Provider Demographics
NPI:1356882369
Name:JIM MCCAULEY MD PC
Entity type:Organization
Organization Name:JIM MCCAULEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-571-3491
Mailing Address - Street 1:427 TANAGER DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8389
Mailing Address - Country:US
Mailing Address - Phone:541-420-9482
Mailing Address - Fax:541-323-3794
Practice Address - Street 1:427 TANAGER DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-8389
Practice Address - Country:US
Practice Address - Phone:541-420-9482
Practice Address - Fax:541-323-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR083662Medicaid
C19052Medicare UPIN
OR083662Medicaid