Healthcare Provider Details

I. General information

NPI: 1972549426
Provider Name (Legal Business Name): AMY C JAMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY C OBENDORF MD

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N 2ND ST
MARSHALL IL
62441-1010
US

IV. Provider business mailing address

PO BOX 2505
INDIANAPOLIS IN
46206-2505
US

V. Phone/Fax

Practice location:
  • Phone: 217-826-2361
  • Fax: 217-826-2366
Mailing address:
  • Phone: 812-238-7783
  • Fax: 812-238-4506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-115678
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01061870A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: