MEDICARE: DR. JAMES NICHOLAS PACE 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	213E00000X	Podiatrist	SC002934L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01692501	OTHER	PA	CAPITAL BLUE CROSS
2	176518	OTHER	PA	PENN. BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES NICHOLAS PACE DPM

Provider Business Mailing Address
First Line	:	916 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3017
Country	:	US
Telephone Number	:	610-376-5649
Fax Number	:	610-376-4194

Provider Business Practice Location Address
First Line	:	916 PENN AVE
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3017
Country	:	US
Telephone Number	:	610-376-5649
Fax Number	:	610-376-4194

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	12/15/2008

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