1285621656 NPI number — WILLIAM FIX O.D.

Table of content: WILLIAM FIX O.D. (NPI 1285621656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285621656 NPI number — WILLIAM FIX O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIX
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1285621656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W DEYOUNG ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62959-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-993-5686
Provider Business Mailing Address Fax Number:
618-997-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 S PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERRIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62948-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-942-2900
Provider Business Practice Location Address Fax Number:
618-942-4199
Provider Enumeration Date:
09/30/2005

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: 152W00000X , with the licence number:  046-007446 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0814870007 . This is a "MEDICARE NSC NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 051353 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 046007446 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0814870001 . This is a "MEDICARE NSC NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0814870019 . This is a "MEDICARE NSC NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL7446 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 237369 . This is a "HARMONY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410039812 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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