James Riley Davidson, MD | |
1000 S Main St, Tipton, IN 46072-9753 | |
(765) 675-8391 | |
(765) 675-6704 |
Full Name | James Riley Davidson |
---|---|
Gender | Male |
Speciality | Emergency Medicine |
Location | 1000 S Main St, Tipton, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1669419693 | NPI | - | NPPES |
807143000 | Medicaid | ID | |
200377830 | Medicaid | IN | |
000000851775 | Other | IN | ANTHEM PIN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 12137 (Montana) | Primary |
207P00000X | Emergency Medicine | 01054498A (Indiana) | Secondary |
207P00000X | Emergency Medicine | M9214 (Idaho) | Secondary |
Entity Name | Emergency Professionals Of Indiana Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1013951219 PECOS PAC ID: 4183604150 Enrollment ID: O20040721000612 |
Entity Name | Indiana University Health Care Associates Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1902032832 PECOS PAC ID: 5799755864 Enrollment ID: O20040727000955 |
Mailing Address | Practice Location Address |
---|---|
James Riley Davidson, MD 250 N Shadeland Ave, Suite 130, Provider Enrollment, Indianapolis, IN 46219-4959 Ph: () - | James Riley Davidson, MD 1000 S Main St, Tipton, IN 46072-9753 Ph: (765) 675-8391 |
Dr. Charles Lai, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1000 S Main St, Tipton, IN 46072 Phone: 765-675-8521 Fax: 765-675-8520 | |
Sherif S Andrews, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1000 S Main Street, Tipton, IN 46072 Phone: 765-675-8397 Fax: 765-675-6704 | |
Dr. Saba Haq, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1000 S Main St, Tipton, IN 46072 Phone: 765-675-8106 Fax: 765-675-8257 |