Healthcare Provider Details

I. General information

NPI: 1801866009
Provider Name (Legal Business Name): JAMES DAVID CARGILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W HIGH ST SUITE 150
LIMA OH
45801-3959
US

IV. Provider business mailing address

750 W HIGH ST SUITE 150
LIMA OH
45801-3959
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-1359
  • Fax: 419-227-7586
Mailing address:
  • Phone: 419-227-1359
  • Fax: 419-227-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35071437
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2018891
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: