Provider Demographics
NPI:1881906543
Name:JAMES A ELEY MD INC
Entity type:Organization
Organization Name:JAMES A ELEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-753-5026
Mailing Address - Street 1:62 CONSERVATORY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-9002
Mailing Address - Country:US
Mailing Address - Phone:330-753-5026
Mailing Address - Fax:330-753-5778
Practice Address - Street 1:62 CONSERVATORY DR
Practice Address - Street 2:SUITE B
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9002
Practice Address - Country:US
Practice Address - Phone:330-753-5026
Practice Address - Fax:330-753-5778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059069261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0768905Medicaid
OHF20617Medicare UPIN
OHEL4033261Medicare PIN