1366409591 NPI number — JAMES R. WATSON, MD, ORTHOPEDIC & SPORTS MEDICINE, PLLC

Table of content: (NPI 1366409591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366409591 NPI number — JAMES R. WATSON, MD, ORTHOPEDIC & SPORTS MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R. WATSON, MD, ORTHOPEDIC & SPORTS MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366409591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-703-9506
Provider Business Mailing Address Fax Number:
601-703-3264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-703-9231
Provider Business Practice Location Address Fax Number:
601-703-6794
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-459-4778

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA8035 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04753271 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 529917890 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122685400 . This is a "US DEPT OF LABOR W/C" identifier . This identifiers is of the category "OTHER".




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