1316998362 NPI number — WILLIAM A CONKRIGHT MD

Table of content: WILLIAM A CONKRIGHT MD (NPI 1316998362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316998362 NPI number — WILLIAM A CONKRIGHT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONKRIGHT
Provider First Name:
WILLIAM
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1316998362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3232 N BALLARD RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54911-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-730-4429
Provider Business Mailing Address Fax Number:
920-734-5307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E CAPITOL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-364-3600
Provider Business Practice Location Address Fax Number:
920-364-3900
Provider Enumeration Date:
05/15/2006

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: 207RH0003X , with the licence number:  MD0000036104 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 57115-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: 37154 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4079558 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 020248399 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000236076 . This is a "UNISON HEALTH PLAN MEDICARE ADVANTAGE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 097607 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1316998362 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23130 . This is a "TLC- FAMILYCAREHLTHPLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 478032 . This is a "HEALTH LINK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: H48373 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000331509 . This is a "ANTHEM BCBS OF KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1202917 . This is a "CHA HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3875576 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64048978 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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