Provider Demographics
NPI:1992370019
Name:BOTWRIGHT, JAMES SAMUEL (MT(AAB), TSO, CIC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SAMUEL
Last Name:BOTWRIGHT
Suffix:
Gender:M
Credentials:MT(AAB), TSO, CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EL PASO BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2451
Mailing Address - Country:US
Mailing Address - Phone:214-940-9177
Mailing Address - Fax:
Practice Address - Street 1:30 EL PASO BLVD APT 8
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2451
Practice Address - Country:US
Practice Address - Phone:214-940-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZB0500X, 251K00000X, 246QH0401X, 246QM0706X, 246QM0900X, 171M00000X, 174H00000X, 246QB0000X
CO20122376207ZB0001X, 207ZI0100X, 207KI0005X, 207ZM0300X, 207ZP0105X
CO105785405300000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No246ZB0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiochemist
No251K00000XAgenciesPublic Health or Welfare
No246QH0401XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHemapheresis Practitioner
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No174H00000XOther Service ProvidersHealth Educator
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking
No405300000XOther Service ProvidersPrevention Professional