MEDICARE: DR. JIM D. BATES D.O.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	1897	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	330005009	OTHER	AZ	MEDICARE RAILROAD

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
2	834640	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1275572992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM D. BATES D.O.

Provider Business Mailing Address
First Line	:	2744 SILVERCREEK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7913
Country	:	US
Telephone Number	:	928-704-7166
Fax Number	:	928-704-7144

Provider Business Practice Location Address
First Line	:	1378 PIONEER TRL
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86429-1112
Country	:	US
Telephone Number	:	928-234-4321
Fax Number	:	928-404-2150

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/19/2019

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