Provider Demographics
NPI:1841295656
Name:BILBO, JAMES THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:BILBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-301-0655
Practice Address - Street 1:2626 ALEXANDRIA PIKE STE 100
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1530
Practice Address - Country:US
Practice Address - Phone:859-301-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24525207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY428850001OtherMEDICARE DME
KYCB8861OtherRAILROAD MEDICARE
KY000000033736OtherANTHEM
KY64245251Medicaid
KY90008962OtherMEDICAID DME
KY200039823OtherRAILROAD MEDICARE
KY90008962OtherMEDICAID DME
KY0389201Medicare PIN
KY428850001OtherMEDICARE DME