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General NPI Number Information
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NPI Number | 1497946818
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Entity Type | Organization
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Legal Business Name | WOLCOTT FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 128 W MARKET STREET
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City | WOLCOTT
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State | IN
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Zip | 47995
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Country | US
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Telephone | 219-279-2264
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Fax | 219-279-2279
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Provider Business Mailing Address
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Address Line | PO BOX 4699
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City | LAFAYETTE
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State | IN
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Zip | 47903-4699
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Country | US
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Telephone | 219-279-2264
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Fax | 219-279-2279
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | JAMES K SHIELDS
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Credential | MD
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Telephone | 219-279-2264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01027166A
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License Number State | IN
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