Healthcare Provider Details

I. General information

NPI: 1205005113
Provider Name (Legal Business Name): JAMES M. PERKINS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST ROOM 2K64
SPRINGFIELD IL
62769-0002
US

IV. Provider business mailing address

800 E CARPENTER ST RM 2K64
SPRINGFIELD IL
62769-0001
US

V. Phone/Fax

Practice location:
  • Phone: 217-525-5643
  • Fax: 217-544-2521
Mailing address:
  • Phone: 217-525-5643
  • Fax: 217-544-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041-338406
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8931-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: