MEDICARE: TRAVIS JAMES 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	363A00000X	Physician Assistant	085.005204	IL

General Provider Information

NPI Number	:	1518200575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS JAMES PA-C

Provider Business Mailing Address
First Line	:	1325 W WHITTAKER ST
Second Line	:	SUITE 3
City	:	SALEM
State	:	IL
Zip	:	62881-2007
Country	:	US
Telephone Number	:	618-548-2400
Fax Number	:	618-548-2402

Provider Business Practice Location Address
First Line	:	1325 W WHITTAKER ST
Second Line	:	SUITE 3
City	:	SALEM
State	:	IL
Zip	:	62881-2007
Country	:	US
Telephone Number	:	618-548-2400
Fax Number	:	618-548-2402

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

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	02/23/2016

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Directions to “ TRAVIS JAMES PA-C” Practice Location

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