Provider Demographics
NPI:1811925282
Name:SPLIT, JAMES F (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:SPLIT
Suffix:
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 1:855 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1241
Mailing Address - Country:US
Mailing Address - Phone:920-846-3444
Mailing Address - Fax:920-846-0250
Practice Address - Street 1:855 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1241
Practice Address - Country:US
Practice Address - Phone:920-846-3444
Practice Address - Fax:920-846-0250
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066745A207L00000X
ND10904207L00000X
WI58255-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16186OtherPARTNERS PROVIDER NUMBER
NC1871958OtherUHC PROVIDER NUMBER
IN000000613636OtherANTHEM-INDIANA
WI1326349135OtherCMH SB NPI
WI1851477913OtherCMH NPI
WI11014110Medicaid
INP00732890OtherRR MEDICARE
NC144MROtherBCBS PROVIDER NUMBER
IN200944960Medicaid
WI1851477913OtherCMH NPI
WI1326349135OtherCMH SB NPI
IN200944960Medicaid
WI521310Medicare Oscar/Certification
NC16186OtherPARTNERS PROVIDER NUMBER
IN249110TMedicare PIN