Healthcare Provider Details

I. General information

NPI: 1992370019
Provider Name (Legal Business Name): JAMES SAMUEL BOTWRIGHT MT(AAB), TSO, CIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 EL PASO BLVD APT 8
MANITOU SPRINGS CO
80829-2451
US

IV. Provider business mailing address

30 EL PASO BLVD APT 8
MANITOU SPRINGS CO
80829-2451
US

V. Phone/Fax

Practice location:
  • Phone: 214-940-9177
  • Fax:
Mailing address:
  • Phone: 214-940-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZB0500X
TaxonomyBiochemist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246QH0401X
TaxonomyHemapheresis Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246QM0900X
TaxonomyMicrobiology Specialist/Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number20122376
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number20122376
License Number StateCO
# 10
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number20122376
License Number StateCO
# 11
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number20122376
License Number StateCO
# 12
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number20122376
License Number StateCO
# 13
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License Number
License Number State
# 14
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number105785
License Number StateCO
# 15
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number105785
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: