Healthcare Provider Details

I. General information

NPI: 1215955471
Provider Name (Legal Business Name): JAMES W. SPAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE RM 482
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

395 W 12TH AVE RM 482
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-4333
  • Fax: 614-293-6935
Mailing address:
  • Phone: 614-293-4333
  • Fax: 614-293-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35-074464
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35-074464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: