Basic Information
| Provider Information | |||||||||
| NPI: | 1033421037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 FAIRMONT BLVD | ||||||||
| Address2: | ATTEN CHRISTIE MSS | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577017375 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2201 JACKSON BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577024386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057552273 | ||||||||
| FaxNumber: | 6057553902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2010 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0741 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.