Provider Demographics
NPI:1780072991
Name:JAMES MATHIS, M.D.
Entity type:Organization
Organization Name:JAMES MATHIS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-218-0730
Mailing Address - Street 1:1411
Mailing Address - Street 2:P.O. BOX 528
Mailing Address - City:PILOT KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:63663-0528
Mailing Address - Country:US
Mailing Address - Phone:573-218-0730
Mailing Address - Fax:
Practice Address - Street 1:1411 RAINBOW AVE,, IRONTON, MO. 63650
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663-0528
Practice Address - Country:US
Practice Address - Phone:573-218-0730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3457291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory