Provider Demographics
NPI:1194701359
Name:SPRINGER, JAMES LEROY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEROY
Last Name:SPRINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FOXBOROUGH RUN
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2879
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 FOXBOROUGH RUN
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176
Practice Address - Country:US
Practice Address - Phone:317-512-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17476207Q00000X
IN01065737A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR032073Medicaid
OR1407812365OtherNBMC GROUP NPI NUMBER
ORP00143357OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
IN201195760Medicaid
ORCB3544OtherRR MEDICARE GROUP NUMBER
INP01307618OtherMEDICARE RR PTAN
INP01307618OtherMEDICARE RR PTAN
OR0577260001Medicare NSC
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORE48280Medicare UPIN
ORR120721Medicare PIN