1043483787 NPI number — WILLIAM J WESTERKAM

Table of content: (NPI 1043483787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043483787 NPI number — WILLIAM J WESTERKAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J WESTERKAM
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:
1043483787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 HARBISON BLVD
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29212-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-749-0181
Provider Business Mailing Address Fax Number:
803-749-3229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 HARBISON BLVD
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29212-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-749-0181
Provider Business Practice Location Address Fax Number:
803-749-3229
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WESTERKAM
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
803-749-0181

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  6229 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06229 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com