Provider Demographics
NPI:1972788784
Name:JAMES R DAVIS MD LLC
Entity type:Organization
Organization Name:JAMES R DAVIS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBBINS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PSYCHIATRIST
Authorized Official - Phone:270-202-2598
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-0213
Mailing Address - Country:US
Mailing Address - Phone:270-202-2598
Mailing Address - Fax:270-622-2606
Practice Address - Street 1:2700 VISSING PARK RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5989
Practice Address - Country:US
Practice Address - Phone:270-202-2598
Practice Address - Fax:270-622-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024043A174400000X
KY33498273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100360240Medicaid
KY64343981Medicaid
E09518Medicare UPIN
IN100360240Medicaid