Basic Information
| Provider Information | |||||||||
| NPI: | 1801866009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARGILL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 W HIGH ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458013959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192271359 | ||||||||
| FaxNumber: | 4192277586 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 W HIGH ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458013959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192271359 | ||||||||
| FaxNumber: | 4192277586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 12/04/2007 | ||||||||
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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 | 207RN0300X | 35071437 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 2018891 | 05 | OH | MEDICAID |