Provider Demographics
NPI:1316054299
Name:MEADE, JAMES C (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:MEADE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 W JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8247
Mailing Address - Country:US
Mailing Address - Phone:219-874-2939
Mailing Address - Fax:219-874-5922
Practice Address - Street 1:6916 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8247
Practice Address - Country:US
Practice Address - Phone:219-874-2939
Practice Address - Fax:219-874-5922
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000785A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1089370002OtherDMERC
IN100148090Medicaid
INCC4485OtherRAILROAD MEDICARE
IN480020342OtherRAILROAD MEDICARE
IN1089370001OtherDMERC
IN492470DMedicare PIN
IN1089370002OtherDMERC
INCC4485OtherRAILROAD MEDICARE