Provider Demographics
NPI:1104256833
Name:JAMES H. MOONEY, MD, LLC
Entity type:Organization
Organization Name:JAMES H. MOONEY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-908-5840
Mailing Address - Street 1:1216 TOWNSHIP ROAD 1506
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4580
Mailing Address - Country:US
Mailing Address - Phone:419-908-5840
Mailing Address - Fax:419-289-6463
Practice Address - Street 1:1216 TOWNSHIP ROAD 1506
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4580
Practice Address - Country:US
Practice Address - Phone:419-908-5840
Practice Address - Fax:419-289-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty