1689746935 NPI number — DR. BENNIE C MCWILLIAMS MD

Table of content: DR. BENNIE C MCWILLIAMS MD (NPI 1689746935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689746935 NPI number — DR. BENNIE C MCWILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCWILLIAMS
Provider First Name:
BENNIE
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:
1689746935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3305 NORTHLAND DR
Provider Second Line Business Mailing Address:
SUITE 512
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-4961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-380-9200
Provider Business Mailing Address Fax Number:
512-380-9201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3305 NORTHLAND DR
Provider Second Line Business Practice Location Address:
SUITE 512
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-4961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-380-9200
Provider Business Practice Location Address Fax Number:
512-380-9201
Provider Enumeration Date:
11/14/2006

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: 2080P0214X , with the licence number:  F1812 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0214X , with the licence number: 81-90 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106192103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com