MEDICARE: JAMES C RICHEY

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	1223G0001X	General Practice Dentistry	3195	LA

General Provider Information

NPI Number	:	1407875156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C RICHEY

Provider Business Mailing Address
First Line	:	PO BOX 1603
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70527-1603
Country	:	US
Telephone Number	:	337-783-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 BLUE LAKE DR
Second Line	:
City	:	CROWLEY
State	:	LA
Zip	:	70526-2356
Country	:	US
Telephone Number	:	337-783-3321
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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Directions to “ JAMES C RICHEY ” Practice Location

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