MEDICARE: DR. JAMES B RICKERT I M.D.

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	207X00000X	Orthopaedic Surgery Physician	01041499A	IN

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

General Provider Information

NPI Number	:	1659375624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES B RICKERT I M.D.

Provider Business Mailing Address
First Line	:	583 S CLARIZZ BLVD
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 16TH ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-279-6506
Fax Number	:	812-275-1268

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	12/21/2020

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