1194777060 NPI number — DR. JOSEPH H WILLIAMS M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194777060 NPI number — DR. JOSEPH H WILLIAMS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JOSEPH
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1194777060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2855 E MAGIC VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-6245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-639-4900
Provider Business Mailing Address Fax Number:
208-639-4901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 E MAGIC VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-6245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-639-4900
Provider Business Practice Location Address Fax Number:
208-639-4901
Provider Enumeration Date:
05/17/2006

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: 208800000X , with the licence number:  5188-320 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 01094248A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: M-7605 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010157308 . This is a "BLUE SHIELD MERIDIAN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: B5608 . This is a "BLUE CROSS BOISE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 76707 . This is a "BLUE CROSS MERIDIAN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 80521180 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010137499 . This is a "BLUE SHIELD BOISE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: P00253274 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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