Provider Demographics
NPI:1669559332
Name:VERT, JAMES P (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:VERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:1131 SALUDA ST.
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-6028
Mailing Address - Country:US
Mailing Address - Phone:803-325-7744
Mailing Address - Fax:803-325-1789
Practice Address - Street 1:1131 SALUDA ST.
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29731-6028
Practice Address - Country:US
Practice Address - Phone:803-325-7744
Practice Address - Fax:803-325-1789
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC1166363A00000X
SC1166363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0785PAMedicaid