MEDICARE: JAMES MEDICAL CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME 0009521	FL

General Provider Information

NPI Number	:	1336311695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES MEDICAL CENTER PA

Provider Business Mailing Address
First Line	:	627 ELDRON DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-7113
Country	:	US
Telephone Number	:	305-885-1623
Fax Number	:	305-885-1811

Provider Business Practice Location Address
First Line	:	627 ELDRON DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-7113
Country	:	US
Telephone Number	:	305-885-1623
Fax Number	:	305-885-1811

Authorized Official
Title or Position	:	DIRECTOR AND PRESIDENT
Name	:	CHARLES C JAMES
Credential	:	M.D.
Telephone Number	:	305-885-1623

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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