1639122088 NPI number — PAULA HALMES WILLIAMS CRNA

Table of content: PAULA HALMES WILLIAMS CRNA (NPI 1639122088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639122088 NPI number — PAULA HALMES WILLIAMS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
PAULA
Provider Middle Name:
HALMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALMES
Provider Other First Name:
PAULA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639122088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 ENTERPRISE BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-454-0888
Provider Business Mailing Address Fax Number:
864-454-1130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 GROVE RD
Provider Second Line Business Practice Location Address:
2ND FLOOR ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-455-7111
Provider Business Practice Location Address Fax Number:
864-455-6441
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APRN2824 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AN1473 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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