MEDICARE: JAMES C LOOMIS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC-003449-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104899103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C LOOMIS DPM

Provider Business Mailing Address
First Line	:	322 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1024
Country	:	US
Telephone Number	:	570-383-4958
Fax Number	:	570-383-3018

Provider Business Practice Location Address
First Line	:	322 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1024
Country	:	US
Telephone Number	:	570-383-4958
Fax Number	:	570-383-3018

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	01/25/2010

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