MEDICARE: DR. JAMES FLETCHER KOON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18339	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080179118	OTHER	SC	RETIRED RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000229650	OTHER	SC	UNISON
3	5532095	OTHER	SC	AETNA
4	8874326	OTHER	SC	PPNI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	01153584	OTHER	SC	AMERIGROUP
7	20071782	OTHER	SC	SELECT HEALTH
8	21149333031	OTHER	SC	BEECHSTREET
9	A8973	OTHER	SC	MEDCOST
10	3091345	OTHER	SC	CIGNA
11	0141069	OTHER	SC	CAROLINA CARE

General Provider Information

NPI Number	:	1093792608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES FLETCHER KOON MD

Provider Business Mailing Address
First Line	:	206 S MATSON ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1506
Country	:	US
Telephone Number	:	803-475-1156
Fax Number	:	803-475-1128

Provider Business Practice Location Address
First Line	:	206 S MATSON ST
Second Line	:
City	:	KERSHAW
State	:	SC
Zip	:	29067-1506
Country	:	US
Telephone Number	:	803-475-1156
Fax Number	:	803-475-1128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/05/2008

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