Provider Demographics
NPI:1194778712
Name:MACSWORDS, JAMES RUSSELL III (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RUSSELL
Last Name:MACSWORDS
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBOURNE WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8004
Mailing Address - Country:US
Mailing Address - Phone:859-570-0007
Mailing Address - Fax:859-570-0500
Practice Address - Street 1:111 OSBOURNE WAY
Practice Address - Street 2:STE 101
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8004
Practice Address - Country:US
Practice Address - Phone:859-570-0007
Practice Address - Fax:859-570-0500
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000402Medicaid
KY0383404Medicare PIN
KYS52790Medicare UPIN
KY95000402Medicaid