1093021156 NPI number — WILLIAM F.M. DANIEL, M.D., F.A.C.S,

Table of content: (NPI 1093021156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093021156 NPI number — WILLIAM F.M. DANIEL, M.D., F.A.C.S,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM F.M. DANIEL, M.D., F.A.C.S,
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:
1093021156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 SCOTTSVILLE RD
Provider Second Line Business Mailing Address:
STE B-2, PMB 354
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-3376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-253-3147
Provider Business Mailing Address Fax Number:
270-253-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 BROOKHAVEN RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-253-3147
Provider Business Practice Location Address Fax Number:
270-253-3156
Provider Enumeration Date:
08/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DANIEL
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
FM
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
270-253-3147

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  26280 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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