1194879882 NPI number — PATRICIA R WILLIAMS CSW

Table of content: PATRICIA R WILLIAMS CSW (NPI 1194879882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194879882 NPI number — PATRICIA R WILLIAMS CSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
PATRICIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSW
Provider Gender Code:
F

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:
1194879882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 263
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSHTEMO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49077-0263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-375-0624
Provider Business Mailing Address Fax Number:
269-375-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3335 S 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-375-0624
Provider Business Practice Location Address Fax Number:
269-375-0008
Provider Enumeration Date:
01/22/2007

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: 104100000X , with the licence number:  6801065401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8008902000 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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