MEDICARE: MR. JAMES WILLIAM ENDICOTT MD

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	207Q00000X	Family Medicine Physician	14258	WV

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	:	1790782753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES WILLIAM ENDICOTT MD

Provider Business Mailing Address
First Line	:	PO BOX 430
Second Line	:
City	:	KERMIT
State	:	WV
Zip	:	25674-0430
Country	:	US
Telephone Number	:	304-393-4303
Fax Number	:	304-393-3254

Provider Business Practice Location Address
First Line	:	108 MINGO ST
Second Line	:
City	:	KERMIT
State	:	WV
Zip	:	25674-0430
Country	:	US
Telephone Number	:	304-393-4303
Fax Number	:	304-393-3254

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	02/02/2023

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