Basic Information
| Provider Information | |||||||||
| NPI: | 1013988161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MASTIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR FL HP2 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153737600 | ||||||||
| FaxNumber: | 8777672310 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 KNOTBREAK RD | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241535404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404444020 | ||||||||
| FaxNumber: | 5404444021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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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 | 207X00000X | 77879 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 0101242061 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00621112 | 01 | VA | MEDICARE RAILROAD | OTHER | 1013988161 | 05 | VA | MEDICAID |