1154459196 NPI number — WILLIAMS RADIOLOGY ASSOCIATES

Table of content: (NPI 1154459196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154459196 NPI number — WILLIAMS RADIOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMS RADIOLOGY ASSOCIATES
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:
6
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:
1154459196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWER WATERFORD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05848-0035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-748-5415
Provider Business Mailing Address Fax Number:
802-748-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 MIDDLE ST
Provider Second Line Business Practice Location Address:
WEEKS MEDICAL CENTER
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-788-4911
Provider Business Practice Location Address Fax Number:
603-788-5062
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
STUART
Authorized Official Title or Position:
RADIOLOGIST
Authorized Official Telephone Number:
802-748-5415

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  6224 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 27116 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 01017837A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0000429 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81300429 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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