Healthcare Provider Details

I. General information

NPI: 1649552464
Provider Name (Legal Business Name): JAMES THREE SEVENTEEN MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST
ANDOVER NY
14806
US

IV. Provider business mailing address

153 W STATE ST
WELLSVILLE NY
14895-1359
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-1372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES RUMMEL
Title or Position: OWNER
Credential: DO
Phone: 607-324-1372