1942408430 NPI number — TAMI O WILLIAMS MD LLC

Table of content: (NPI 1942408430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942408430 NPI number — TAMI O WILLIAMS MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAMI O WILLIAMS MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1942408430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE GIRARDEAU
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63702-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-334-0515
Provider Business Mailing Address Fax Number:
573-334-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3262 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63701-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-334-0515
Provider Business Practice Location Address Fax Number:
573-334-1120
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
TAMI
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-334-0515

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  2000156016 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1863120 . This is a "COVENTRY FIRST HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 434499 . This is a "HEALTHLINK PROVIDER #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 128569 . This is a "BLUE CROSS PROVIDER #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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