1932619459 NPI number — WILLIAM MILLS

Table of content: WILLIAM MILLS (NPI 1932619459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932619459 NPI number — WILLIAM MILLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1932619459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14225-0255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-380-0233
Provider Business Mailing Address Fax Number:
716-322-0673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 MARYVALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14225-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-380-0633
Provider Business Practice Location Address Fax Number:
716-551-0900
Provider Enumeration Date:
10/11/2017

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: 343900000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04483203 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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