MEDICARE: JAMES C LOOMIS 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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC003449L	PA

General Provider Information

NPI Number	:	1891979654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES C LOOMIS DPM

Provider Business Mailing Address
First Line	:	322 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1024
Country	:	US
Telephone Number	:	570-383-4958
Fax Number	:	570-383-3018

Provider Business Practice Location Address
First Line	:	322 CHURCH ST
Second Line	:
City	:	JESSUP
State	:	PA
Zip	:	18434-1024
Country	:	US
Telephone Number	:	570-383-4958
Fax Number	:	570-383-3018

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES C LOOMIS
Credential	:	DPM
Telephone Number	:	570-383-4958

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/28/2007

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