1679059240 NPI number — CAITLYN JUSTINE WILLIAMS PA

Table of content: CAITLYN JUSTINE WILLIAMS PA (NPI 1679059240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679059240 NPI number — CAITLYN JUSTINE WILLIAMS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
CAITLYN
Provider Middle Name:
JUSTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASBURY
Provider Other First Name:
CAITLYN
Provider Other Middle Name:
JUSTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679059240
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 SUMMIT AVENUE
Provider Second Line Business Mailing Address:
MSO PHYSICIAN BILLING
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-283-7597
Provider Business Mailing Address Fax Number:
740-283-7807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-318-1794
Provider Business Practice Location Address Fax Number:
234-285-6816
Provider Enumeration Date:
07/17/2018

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: 363AM0700X , with the licence number:  2179 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 50.006522RX , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0310839 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".