MEDICARE: J. TIMOTHY AMES, MD PC

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	261QP2300X	Primary Care Clinic/Center

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	:	1811550601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. TIMOTHY AMES, MD PC

Provider Business Mailing Address
First Line	:	751 E PORTER AVE STE 5
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9111
Country	:	US
Telephone Number	:	219-767-4858
Fax Number	:	219-413-9682

Provider Business Practice Location Address
First Line	:	751 E PORTER AVE STE 5
Second Line	:
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9111
Country	:	US
Telephone Number	:	219-767-4858
Fax Number	:	219-413-9682

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAY TIMOTHY AMES
Credential	:	MD
Telephone Number	:	219-767-4858

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	04/17/2019

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