MEDICARE: JAMES C STEWART PHD PROFESSIONAL CORPORATION

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	103G00000X	Clinical Neuropsychologist	1696	CO

General Provider Information

NPI Number	:	1316252521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C STEWART PHD PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2020 BRAMBLWOOD LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1588
Country	:	US
Telephone Number	:	719-244-5652
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 BRAMBLWOOD LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1588
Country	:	US
Telephone Number	:	719-244-5652
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES CHRISTOPHER STEWART
Credential	:	PHD
Telephone Number	:	719-244-5652

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	08/11/2010

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