Provider Demographics
NPI:1427172014
Name:PODIATRIC MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:PODIATRIC MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEADE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-874-2939
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1089370002OtherDMERC
IN213580Medicare ID - Type UnspecifiedMEDICARE NUMBER
IN1089370002Medicare NSC
IN213580Medicare PIN