1134150873 NPI number — DR. PILAR M WILLIAMSEN DC

Table of content: DR. PILAR M WILLIAMSEN DC (NPI 1134150873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134150873 NPI number — DR. PILAR M WILLIAMSEN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSEN
Provider First Name:
PILAR
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1134150873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2821 N BALLAS RD STE C55
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-989-1805
Provider Business Mailing Address Fax Number:
314-989-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2821 N BALLAS RD STE C55
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-2386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-989-1805
Provider Business Practice Location Address Fax Number:
314-989-1836
Provider Enumeration Date:
07/05/2006

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: 111N00000X , with the licence number:  2001020192 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: 2001020192 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4401692 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 165742 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7511503 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".