Provider Demographics
NPI:1972549426
Name:JAMES, AMY C (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:OBENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2505
Mailing Address - Country:US
Mailing Address - Phone:812-238-7783
Mailing Address - Fax:812-238-4506
Practice Address - Street 1:410 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1010
Practice Address - Country:US
Practice Address - Phone:217-826-2361
Practice Address - Fax:217-826-2366
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115678207Q00000X
IN01061870A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115478Medicaid
INP00447711OtherRR MEDICARE
IN200847950Medicaid
INM400032102Medicare PIN
IN130910FFMedicare PIN
IN854700DDDDMedicare PIN
IN941090Z8Medicare PIN
INP00447711OtherRR MEDICARE
I06193Medicare UPIN
IL036115478Medicaid
INP00447711Medicare PIN