MEDICARE: MR. JAMES D. WELSH PA-C

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	363AM0700X	Medical Physician Assistant	50-002096	OH
2	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1467417386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES D. WELSH PA-C

Provider Business Mailing Address
First Line	:	P.O. BOX 1965
Second Line	:	SEPI
City	:	SPRINGFIELD
State	:	OH
Zip	:	45501
Country	:	US
Telephone Number	:	937-399-3571
Fax Number	:	937-717-9028

Provider Business Practice Location Address
First Line	:	1427 BUSINESS CENTER CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-3300
Country	:	US
Telephone Number	:	937-254-0160
Fax Number	:	937-254-1478

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	01/04/2010

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