Healthcare Provider Details

I. General information

NPI: 1811550601
Provider Name (Legal Business Name): J. TIMOTHY AMES, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E PORTER AVE STE 5
CHESTERTON IN
46304-9111
US

IV. Provider business mailing address

751 E PORTER AVE STE 5
CHESTERTON IN
46304-9111
US

V. Phone/Fax

Practice location:
  • Phone: 219-767-4858
  • Fax: 219-413-9682
Mailing address:
  • Phone: 219-767-4858
  • Fax: 219-413-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY TIMOTHY AMES
Title or Position: OWNER
Credential: MD
Phone: 219-767-4858