Provider Demographics
NPI:1700046349
Name:MITCHELL, JAMES H
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:H
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N SCIENCE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1419
Mailing Address - Country:US
Mailing Address - Phone:573-324-5985
Mailing Address - Fax:
Practice Address - Street 1:305 N SCIENCE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1419
Practice Address - Country:US
Practice Address - Phone:573-324-5985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO85Medicaid