Healthcare Provider Details

I. General information

NPI: 1841603735
Provider Name (Legal Business Name): MR. JAMES PITCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

IV. Provider business mailing address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number960205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: