1629015268 NPI number — MR. MICHAEL D WILLIAMS MSN- CRNA

Table of content: MR. MICHAEL D WILLIAMS MSN- CRNA (NPI 1629015268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629015268 NPI number — MR. MICHAEL D WILLIAMS MSN- CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN- CRNA
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:
1629015268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12752 KINGSTON PIKE
Provider Second Line Business Mailing Address:
STE E202
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37934-0948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-777-0909
Provider Business Mailing Address Fax Number:
865-777-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37821-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-777-0909
Provider Business Practice Location Address Fax Number:
865-777-0910
Provider Enumeration Date:
06/01/2006

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: 367500000X , with the licence number:  4704212626 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: C01487 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R008864 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 2002008561 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 13682 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: R0088764 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: R54267 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000599493 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 010672601002 . This is a "BCBSOK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 7100064580 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4193075 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00695344 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00695341 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1509646 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200112930A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00695340 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1629015268 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com