MEDICARE: JAMES RILEY DAVIDSON 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	207P00000X	Emergency Medicine Physician	01054498A	IN
2	207P00000X	Emergency Medicine Physician	12137	MT
3	207P00000X	Emergency Medicine Physician	M9214	ID

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
2	000000851775	OTHER	IN	ANTHEM PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669419693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RILEY DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:	SUITE 130, PROVIDER ENROLLMENT
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S MAIN ST
Second Line	:
City	:	TIPTON
State	:	IN
Zip	:	46072-9753
Country	:	US
Telephone Number	:	765-675-8391
Fax Number	:	765-675-6704

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	12/11/2025

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Directions to “ JAMES RILEY DAVIDSON M.D.” Practice Location

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