MEDICARE: DR. JAMES G CLAY DPM

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	213E00000X	Podiatrist	5901001439	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480006462	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	JC001439	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1861479669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES G CLAY DPM

Provider Business Mailing Address
First Line	:	4310 LEONARD ST NW
Second Line	:	SUITE 103
City	:	WALKER
State	:	MI
Zip	:	49534
Country	:	US
Telephone Number	:	616-453-6329
Fax Number	:	616-453-1725

Provider Business Practice Location Address
First Line	:	669 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7903
Country	:	US
Telephone Number	:	616-457-7171
Fax Number	:	616-457-1121

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	01/28/2011

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