Provider Demographics
NPI:1992719462
Name:UPCHURCH, JAMES DAVID
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:UPCHURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 36 BOX 2010
Mailing Address - Street 2:PERITSA CREEK RD
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034
Mailing Address - Country:US
Mailing Address - Phone:406-638-3442
Mailing Address - Fax:406-638-3482
Practice Address - Street 1:10110 S 7650 E
Practice Address - Street 2:CROW NORTHERN CHEYENNE INDIAN HOSPITAL
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3442
Practice Address - Fax:406-638-3482
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38887Medicare UPIN