MEDICARE: MR. JAMES KEITH HOMRIGHAUSEN DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12010004	IN
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7213	KY
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	12010004	IN
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	7213	KY

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811970254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES KEITH HOMRIGHAUSEN DMD

Provider Business Mailing Address
First Line	:	5120 CHARLESTOWN RD
Second Line	:	STE 1
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9497
Country	:	US
Telephone Number	:	812-944-4000
Fax Number	:	812-944-4505

Provider Business Practice Location Address
First Line	:	5120 CHARLESTOWN RD
Second Line	:	STE 1
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-9497
Country	:	US
Telephone Number	:	812-944-4000
Fax Number	:	812-944-4505

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	11/21/2014

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