MEDICARE: JAMES MICHAEL FEENEY MD FACC

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	207RC0000X	Cardiovascular Disease Physician	G45181	CA
2	207RI0011X	Interventional Cardiology Physician	11883316-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ60314Z	OTHER	CA	BLUE SHIELD GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386624377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL FEENEY MD FACC

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W BULLDOG BLVD
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3311
Country	:	US
Telephone Number	:	801-357-7081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/07/2024

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