Provider Demographics
NPI:1982621918
Name:JAMES P WIRE MD PA
Entity Type:Organization
Organization Name:JAMES P WIRE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-442-8045
Mailing Address - Street 1:3000 HUNDERTMARK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1150
Mailing Address - Country:US
Mailing Address - Phone:952-442-8045
Mailing Address - Fax:952-556-2658
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:952-442-8045
Practice Address - Fax:952-556-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43087174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH20075Medicare UPIN