1013191279 NPI number — DR. CAROLINE B WILLIAMS PH.D., M.P.

Table of content: DR. CAROLINE B WILLIAMS PH.D., M.P. (NPI 1013191279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013191279 NPI number — DR. CAROLINE B WILLIAMS PH.D., M.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
CAROLINE
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., M.P.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1013191279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 ESCALERA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-2963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-779-4401
Provider Business Mailing Address Fax Number:
800-866-8791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BROOKE ARMY MEDICAL CENTER
Provider Second Line Business Practice Location Address:
3551 ROGER BROOKE DR
Provider Business Practice Location Address City Name:
FORT SAM HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78234-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-304-3010
Provider Business Practice Location Address Fax Number:
800-866-8791
Provider Enumeration Date:
12/24/2007

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: 103TC0700X , with the licence number:  0911 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP0016X , with the licence number: 00911 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP0016X , with the licence number: 20 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14880300 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".