1972771020 NPI number — MS. EMILY ELIZABETH WILLIAMS PA-C

Table of content: MS. EMILY ELIZABETH WILLIAMS PA-C (NPI 1972771020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972771020 NPI number — MS. EMILY ELIZABETH WILLIAMS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
EMILY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALLY
Provider Other First Name:
EMILY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972771020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HAWKINS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52242-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-384-7898
Provider Business Mailing Address Fax Number:
319-384-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S CLINTON ST STE 168
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52240-4034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-384-7898
Provider Business Practice Location Address Fax Number:
319-384-0603
Provider Enumeration Date:
02/12/2008

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: 363A00000X , with the licence number:  001836 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 085003198 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 001836 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8122859 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1932193224 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16-1801 . This is a "MEDICARE UGS GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972771020 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13238 . This is a "WELLMARK BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 161935 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932193224 . This is a "CLINIC NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1972771020 . This is a "BC/BS OF IOWA INDIVIDUAL" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".