Healthcare Provider Details

I. General information

NPI: 1952570947
Provider Name (Legal Business Name): MR. JAMES KLEMENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MCKINLEY AVE
DECATUR IL
62526-3286
US

IV. Provider business mailing address

PO BOX 2170
DECATUR IL
62524-2170
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3682
  • Fax: 217-876-3345
Mailing address:
  • Phone: 217-876-3682
  • Fax: 217-876-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: