1588667638 NPI number — DR. WILLIAM C PILCHER MD

Table of content: DR. WILLIAM C PILCHER MD (NPI 1588667638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588667638 NPI number — DR. WILLIAM C PILCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILCHER
Provider First Name:
WILLIAM
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
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:
1588667638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1824 KING STREET
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32204-4736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-388-1820
Provider Business Mailing Address Fax Number:
904-388-1827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1824 KING STREET
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32204-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-388-1820
Provider Business Practice Location Address Fax Number:
904-388-1827
Provider Enumeration Date:
05/23/2005

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: 207RC0000X , with the licence number:  ME68414 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 032024 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00532485C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510265 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 251286600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27888 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 208143 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00706626A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0897705 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".